| NPI | 1760727325 |
|---|---|
| Other Name | 63 SHAKER ROAD-SUITE 102 |
| Entity Type | Organization |
| Authorized Contact | PAUL GORDON Dir Fin/Admin Phys Enterprise 518-525-1585 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2014-01-21 |