| NPI | 1689737587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE L LORA Com PT Roller 212-289-1004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NY 170811100) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2014-10-22 |