| NPI | 1801129242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD ROBERT WALDORF Owner 518-526-9996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MA 235587) |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2009-09-17 |