| NPI | 1982314035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER PEGUERO-MEDRANO Owner 631-388-7080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-11-30 |
| Last Update Date | 2022-12-30 |