| NPI | 1912644972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILYA KIBLITSKY Sole Member 917-584-1409 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist | |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2022-05-19 |