| NPI | 1780296533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN CIERZNIEWSKI CEO 631-512-1567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QH0100X Clinic/Center Health Service | |
| 261QP2300X Clinic/Center Primary Care | |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2020-08-21 |