| NPI | 1679949036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON MICHNOVICZ Nominee Owner 516-246-4893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2022-07-08 |