| NPI | 1811152580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA A HICKS Billing Coordinator 845-358-8800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 132575) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 132595) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2015-04-14 |