| NPI | 1912346420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA A FULLER Billing Manager 631-661-0400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: NY 174108AN) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2013-06-18 |