| NPI | 1982006102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KETEVAN VLADI Member 917-753-4770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL me103381) |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2014-09-18 |