| NPI | 1821375940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK DARYL TIEMAN President 631-424-9844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NY 179172) |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2011-11-03 |