| NPI | 1982876983 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA MELO'KENNEDY Lpn 718-545-2030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY 254997) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2008-03-31 |