| NPI | 1558545053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JOHN SOUTHWICK Secretary 845-620-7329 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY 7281441) |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2017-08-17 |