| NPI | 1659635357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL WONG Manager 516-263-8190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 003113) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2012-06-27 |