| NPI | 1952670374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AVIONNE P. ALLEN-SINGH Secretary 866-667-0517 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine |
| Additional Taxonomies | 133N00000X Nutritionist |
| 207Q00000X Family Medicine | |
| 207QA0505X Family Medicine Adult Medicine | |
| 207QG0300X Family Medicine Geriatric Medicine | |
| 207R00000X Internal Medicine | |
| 213E00000X Podiatrist | |
| 235Z00000X Speech-Language Pathologist | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2011-12-14 |