| NPI | 1891576591 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KISUN DEVON PETERS-DIAZ Executive Director 917-861-2531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 247ZC0005X Pathology, Clinical Laboratory Director, Non-physician |
| Enumeration Date | 2023-10-09 |
| Last Update Date | 2023-10-09 |