| NPI | 1699076083 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA LOO MARN Practice Owner 212-965-8113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 0497501) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: NY 0535941) |
| Enumeration Date | 2010-11-16 |
| Last Update Date | 2013-01-24 |