| NPI | 1962160622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE SAMANTHA DEMARCO Owner/Functional Med. Specialist 631-300-6320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Additional Taxonomies | 261QC1500X Clinic/Center Community Health |
| 261QC1800X Clinic/Center Corporate Health | |
| 335G00000X Medical Foods Supplier | |
| Enumeration Date | 2021-11-30 |
| Last Update Date | 2021-11-30 |