| NPI | 1760138648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLIMY JACOBS Authrorized Official 845-662-2404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2022-03-01 |
| Last Update Date | 2023-04-26 |