| NPI | 1679979140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARVIN LOUIS EBERT Physician 516-829-9267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 100787) |
| Enumeration Date | 2014-11-11 |
| Last Update Date | 2014-11-11 |