| NPI | 1679995690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY GEISLER Officer 516-902-3902 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| Enumeration Date | 2014-01-09 |
| Last Update Date | 2014-01-22 |