| NPI | 1013003359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEIDI JILL MOORE Owner Md 518-324-2040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 2242461) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 2239121) |
| 208000000X Pediatrics (Licence: NY 0031261) | |
| 208000000X Pediatrics (Licence: NY 2241781) | |
| 208000000X Pediatrics (Licence: 2328181) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2020-08-22 |