| NPI | 1790833028 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER I. GORDON Executive Administrator 718-579-6017 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 006007) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2008-08-19 |