| NPI | 1336654052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT SHAVER Practice Manager 518-273-3732 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NY 203943-1) |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2017-12-04 |