| NPI | 1902205933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLEG RYBALOV President 917-417-7344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 022591) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2014-08-14 |