| NPI | 1265208052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE ODONNELL Sr. Manager, Compliance 845-721-6214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 103T00000X Psychologist |
| 133V00000X Dietitian, Registered | |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2023-12-01 |
| Last Update Date | 2023-12-01 |