| NPI | 1861766123 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | DEBORAH JAMES EPPS CEO 631-435-0421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY r033117) |
| Enumeration Date | 2012-03-05 |
| Last Update Date | 2012-03-05 |