| NPI | 1649868407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVA BOONE Owner 917-574-8281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207RE0101X Internal Medicine Endocrinology, Diabetes & Metabolism |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2021-01-07 |