| NPI | 1730463183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA PERSAUD Medical Director 212-685-1004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NY 254812) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: NY 004553) |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: NY 032406) | |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2011-10-04 |