| NPI | 1962648964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE DANTES THEODORE President 631-960-2544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 185234) |
| Enumeration Date | 2008-12-21 |
| Last Update Date | 2008-12-21 |