| NPI | 1790093508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE ROBERTS Staff Nurse 718-918-8892 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: NY 487360-1) |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2010-09-15 |