| NPI | 1700911377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORIS VALLEJO Physician 718-515-8600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 189917) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2008-07-15 |