| NPI | 1649675604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARC RYBSTEIN President 516-307-9618 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 012651) |
| Enumeration Date | 2014-11-01 |
| Last Update Date | 2018-01-19 |