| NPI | 1942420989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUS MANTIA Owner 631-208-4460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 005442) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 124142) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2010-02-24 |