| NPI | 1669859294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY FONG Member 516-241-9760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 056689-1) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2015-05-04 |