| NPI | 1861817173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN OSTROW Chief Executive Officer 516-277-2055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2014-02-24 |