| NPI | 1679828792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY ALICIA COGER Licensed Practical Nurse 646-335-3733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: NY 190754-1) |
| Enumeration Date | 2012-07-15 |
| Last Update Date | 2012-07-15 |