| NPI | 1417344987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESS DAVID COLLINS President 518-258-4033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: NY 260870) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: NJ 25MA10413300) |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: PA MD463651) | |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2018-08-01 |