| NPI | 1164767828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY KNOWLES Credentialing Manager 518-525-5634 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| 363LA2200X Nurse Practitioner Adult Health | |
| 133NN1002X Nutritionist Nutrition, Education | |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2021-10-07 |