| NPI | 1972817344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEVERLEY NEEDHAM Vice President 718-218-9800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 9955L001) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2010-07-28 |