| NPI | 1922475235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARYL BRUCE EVERETT Controller 212-361-1678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2015-08-24 |