| NPI | 1639504699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY KNOWLES Credentialing Manager 518-525-5634 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RH0002X Internal Medicine Hospice and Palliative Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207RG0300X Internal Medicine Geriatric Medicine | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2021-10-28 |