| NPI | 1568020733 |
|---|---|
| Other Name | HQMP POUGH. NEUROSURG. |
| Entity Type | Organization |
| Authorized Contact | GLENN LOOMIS CFO 845-475-9661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2019-06-03 |