| NPI | 1043618499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARK DANIEL PINSON Psychologist 315-514-0401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: NY 020187) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: NY 020187) |
| 305R00000X Preferred Provider Organization (Licence: NY 020187) | |
| 305S00000X Point of Service (Licence: NY 020187) | |
| Enumeration Date | 2014-12-17 |
| Last Update Date | 2014-12-17 |