| NPI | 1093771677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARENCE B HENRY President 518-828-7188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 209006) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 123180) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 109985) | |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2011-11-04 |