| NPI | 1811153216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTONIO L. DEL VALLE President 917-450-6531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: NY 048825-1) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2008-08-05 |