| NPI | 1639601982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN BENJAMIN KOSTERICH Doctor 914-636-4113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY x012930) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2017-03-28 |