| NPI | 1164749057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIMON OVANESSAIN Physician/Surgeon 845-548-6073 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: CT 042079) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: CT 042079) |
| Enumeration Date | 2010-05-01 |
| Last Update Date | 2013-04-04 |