| NPI | 1689565194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEAN MARIE Employee 631-867-2695 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 363LW0102X Nurse Practitioner, Women's Health | |
| Enumeration Date | 2025-07-12 |
| Last Update Date | 2025-07-12 |