| NPI | 1255570370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA GOULD Supervisor Of Credentialing 518-437-5516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 103T00000X Psychologist |
| 104100000X Social Worker | |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2009-02-12 |
| Last Update Date | 2024-05-02 |