| NPI | 1669843413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALIK R. DEAN Credentialing Manager 718-559-0555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NY 089076) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2015-10-19 |