| NPI | 1912390717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOMAS WHARTON CEO 718-219-7927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2016-10-13 |