| NPI | 1902686926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATALYA BULYCHEVA Billing Credentialing Manager 917-392-3274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2023-10-05 |