| NPI | 1629415740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN STAHURA Director 518-583-8346 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 122300000X Dentist |
| 207R00000X Internal Medicine | |
| 251S00000X | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2021-04-02 |