| NPI | 1659158624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN GOODEN COO 516-984-9771 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QP1100X Clinic/Center, Podiatric | |
| Enumeration Date | 2023-09-12 |
| Last Update Date | 2023-09-12 |