| NPI | 1134153075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY BRUCE Practice Administrator 845-339-4191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: N/A) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2022-01-10 |