| NPI | 1912048331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA I BETANCOURT Owner 212-532-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 182264) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2009-06-10 |