| NPI | 1811364334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILENE GILBERT-DROGE COO 947-917-8720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: FL ME57672) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: FL ME80960) |
| 2080A0000X Pediatrics Adolescent Medicine (Licence: FL ME88696) | |
| 2080A0000X Pediatrics Adolescent Medicine (Licence: FL ME22185) | |
| 2080A0000X Pediatrics Adolescent Medicine (Licence: FL ME102035) | |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2015-09-01 |