| NPI | 1982243887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISOL BRAVO Admin Assistant/ Credentialing 718-933-1900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2019-12-26 |
| Last Update Date | 2019-12-26 |