| NPI | 1952158297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY KOO Licensing And Credentialing Manager 646-876-8455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 1041C0700X Social Worker Clinical | |
| 133V00000X Dietitian, Registered | |
| 207RG0100X Internal Medicine Gastroenterology | |
| 363A00000X Physician Assistant | |
| 103T00000X Psychologist | |
| Enumeration Date | 2024-05-03 |
| Last Update Date | 2024-07-16 |