| NPI | 1922415009 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW FUNDO President 718-544-2929 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 054916) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2014-07-21 |