| NPI | 1780136259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUY ROBERT EDOUARD Counselor 718-791-1094 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY 003602) |
| Enumeration Date | 2016-10-31 |
| Last Update Date | 2016-10-31 |