| NPI | 1700235397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA DENNIE Credentialing Specialist Affiliate 718-886-7633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NY 998586405) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2016-06-06 |