| NPI | 1992255889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA BALL Provider Enrollment Manager 516-945-3000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA G130650) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2021-07-02 |