| NPI | 1932663259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH W. WEBER-LOPEZ Authorized Official 631-944-3020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2019-01-31 |