| NPI | 1629423900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY KNOWLES Credentialing Manager 518-525-5634 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2021-10-07 |