| NPI | 1801172085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMIE RACHUNOW Officer 212-510-7020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 177709-3) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x010496-1) |
| 207Q00000X Family Medicine (Licence: NY 220017-1) | |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2017-01-16 |