| NPI | 1861733370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEAN ANTHONY BASULTO Solo Owner 718-665-2900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 205919) |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2013-03-07 |