| NPI | 1811715774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE LADUCA Creentialing Manager 845-702-2711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine |
| Enumeration Date | 2024-09-30 |
| Last Update Date | 2024-12-19 |