| NPI | 1982862595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YELENA DUBOV Medical Administrator 718-332-4111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: NY 233503) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2012-09-10 |