| NPI | 1750653622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FOUZIA SYED Physician 718-859-5171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 244019) |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2012-02-07 |