| NPI | 1679653448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ANDREW FANTL Doctor President 631-979-2842 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: NY 1988811) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2008-05-13 |