| NPI | 1972382018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN WIESEN Owner 631-759-9866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease |
| Enumeration Date | 2023-09-27 |
| Last Update Date | 2023-12-06 |