| NPI | 1306050869 |
|---|---|
| Former Legal Business Name | EXECUTIVE ASSOCIATES, LLC |
| Entity Type | Organization |
| Authorized Contact | DIANE BERTUZZI Practice Manager 845-304-6110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2016-05-26 |