| NPI | 1932707452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANNETTE GONZALEZ SIMON Medical Director 917-294-4620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2020-10-16 |
| Last Update Date | 2020-10-16 |