| NPI | 1558169623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH EDICK Healthcare Administrator 518-788-7983 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-03-05 |
| Last Update Date | 2025-03-05 |