| NPI | 1790191427 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIMOS KANAKOUDAS President 631-689-8662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 257261) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2014-07-02 |