| NPI | 1326494691 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY KNOWLES Credentialing Manager 518-525-5634 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208D00000X General Practice | |
| 163W00000X Registered Nurse | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 207P00000X Emergency Medicine | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2021-10-07 |