| NPI | 1417195801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAIL MARIE PURVIS Site Director 2126-858-6856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: NY R032876) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: NY R032876) |
| 305S00000X Point of Service (Licence: NY R032876) | |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2009-01-23 |