| NPI | 1639190630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUIS MARCELO FANDOS Principal, Director 631-422-6166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2020-04-08 |