| NPI | 1952780736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA SONYA STOCKMAN Owner 631-758-5635 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NY F302133-1) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: NY F381245-1) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2015-05-26 |