| NPI | 1841884954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE JORDAN Manager 754-241-9094 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207N00000X Dermatology |
| 207Q00000X Family Medicine | |
| 207W00000X Ophthalmology | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry | |
| 208800000X Urology | |
| 213E00000X Podiatrist | |
| 251S00000X | |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2022-01-04 |