| NPI | 1649442229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA MOJICA Billing And Credentialing Manager 917-485-7291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: NY 6396001A) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 261QD1600X Clinic/Center, Developmental Disabilities (Licence: NY 070311541) | |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2022-03-17 |