| NPI | 1760845424 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE DAVIEDS Office Manager 631-758-6565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY f382507) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2016-03-31 |