| NPI | 1831463249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRECIA A KELLOGG Aba Service Provider 914-450-2399 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305S00000X Point of Service (Licence: NY 72070938) |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2012-03-02 |