| NPI | 1891180212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FABIOLA MILORD Owner 516-216-5656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY 045702) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2015-04-02 |