| NPI | 1649303074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLAINA KISHBAUGH Office Coordinator 607-797-9036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 147249) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2011-03-29 |