| NPI | 1366102444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA A BURKE MUSCATELLO Owner 518-782-3815 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-12-30 |
| Last Update Date | 2021-12-30 |