| NPI | 1639442742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY R RIDHA Owner 518-306-5466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: NY 229760) |
| Enumeration Date | 2012-02-21 |
| Last Update Date | 2015-12-09 |