Organization
VISTA MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ABIOLA FAMILUSI (PHYSIATRIST)
(347) 256-1956
Entity
Organization
Contact information
Practice address
2488 GRAND CONCOURSE, BRONX, NY 10458-5203
(718) 733-1000
Mailing address
1428 30TH AVE, ASTORIA, NY 11102-3641
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
032642
NY
Other
Enumeration date
07/23/2014
Last updated
07/23/2014
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