| NPI | 1669192712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MINOO PEDEOM-SHAPIRO Authorized Official 845-562-2191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2023-01-23 |