| NPI | 1922414341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE HALL BEARS Lpn 212-470-9986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 3147221) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2014-07-07 |