| NPI | 1811350242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNA L BUTNER President 516-721-6717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 270676) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0401X Family Medicine, Addiction Medicine | |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2021-09-21 |