| NPI | 1962758557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MUMTAZ JAHAN Director 718-576-6667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 216654) |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2012-08-01 |