| NPI | 1275215972 |
|---|---|
| Doing Business As | HERITAGE CLINIC |
| Entity Type | Organization |
| Authorized Contact | OLEKSANDR SELEVERSTOV Owner 518-801-6446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Enumeration Date | 2023-08-02 |
| Last Update Date | 2023-08-29 |