| NPI | 1730524455 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FERNANDO SEBASTIAN MORA-MCLAUGHLIN Medical Director 718-993-5093 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 212244) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2014-09-02 |