| NPI | 1982998761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANA KAZHILOTI Credentialing Specialist 718-934-6714 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 161694) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2015-11-03 |