| NPI | 1962876300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YURY F FAYDA Physician 718-206-4420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NY 172367-2) |
| Enumeration Date | 2015-11-23 |
| Last Update Date | 2015-11-23 |