| NPI | 1790790574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOROTHEA KELLIGREW Medical Billing Manager 914-631-3640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 204658) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2020-08-22 |