| NPI | 1437502325 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH ARIE Credentials Manager 315-772-6214 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1100X Clinic/Center, MilitaryU.S. Coast Guard Outpatient (Licence: NY 1053724807) |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2016-07-15 |