| NPI | 1780981407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY DICANIO Medical Doctor 631-665-4392 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: NY 014447) |
| Enumeration Date | 2011-02-15 |
| Last Update Date | 2011-02-15 |