| NPI | 1649716754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SYED SHAH H QADRI Owner 718-343-7790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 259223) |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2017-01-12 |