| NPI | 1952441420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIKOLAI LAGODUKE Owner 877-849-4917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 233906) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030904) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2009-07-14 |