| NPI | 1336855683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE CONWAY-RUSSELL Provider Enrollment Specialist 315-253-1838 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207RC0000X Internal Medicine Cardiovascular Disease |
| 207RE0101X Internal Medicine Endocrinology, Diabetes & Metabolism | |
| 207RN0300X Internal Medicine Nephrology | |
| 207RP1001X Internal Medicine Pulmonary Disease | |
| 207RS0012X Internal Medicine Sleep Medicine | |
| 2084N0400X Psychiatry & Neurology Neurology | |
| 208800000X Urology | |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-01-30 |