| NPI | 1972743326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHADEFAI ZSALINN GOLDSMITH Licensed Practical Nurse 585-413-3762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: NY 295552) |
| Enumeration Date | 2009-02-25 |
| Last Update Date | 2012-06-14 |