| NPI | 1720371248 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ABELA Billing Specialist 631-543-0004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
| Additional Taxonomies | 207W00000X Ophthalmology |
| 225100000X Physical Therapist | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2019-03-27 |