| NPI | 1780077453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL MCCARTHY Recruiter 212-564-2350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 000706-1) |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2015-03-05 |