| NPI | 1902228158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR ALEXEY ROBINSON Owner 516-312-7690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY 055155) |
| Enumeration Date | 2014-01-07 |
| Last Update Date | 2014-01-07 |