| NPI | 1750539060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIEJO OMEDES Office Manager 631-271-9151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 128476) |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2008-08-29 |