| NPI | 1225212715 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD D. ALLEN Assistant Secretary Legal 845-620-7330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY 6480440) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: NY 6480441) |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2016-02-09 |