| NPI | 1902103864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE MAGLIULO President 631-969-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NY 183975) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: NY 183013) |
| Enumeration Date | 2011-02-11 |
| Last Update Date | 2011-02-11 |