| NPI | 1972059467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED WONG CFO 212-947-5770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2019-06-28 |