| NPI | 1679745764 |
|---|---|
| Doing Business As | FOURTH STREET FAMILY MEDICINE |
| Entity Type | Organization |
| Authorized Contact | DHANRAJ JATTAN SOOGREE Owner 315-342-2521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 210443) |
| Enumeration Date | 2008-03-28 |
| Last Update Date | 2010-02-22 |