| NPI | 1770642076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RESITUTO ACOSTA Owner 315-337-2582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry |
| 2084P0805X Psychiatry & Neurology Geriatric Psychiatry | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2020-08-22 |