| NPI | 1922388008 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYDIA SHAJENKO President 646-712-1635 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: NJ 25MA08061700) |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2011-08-22 |