| NPI | 1871713636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WHALEN Director Of Administration 518-435-2704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 54964) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: NY 54964) |
| 207R00000X Internal Medicine (Licence: NY 54964) | |
| 363LA2200X Nurse Practitioner Adult Health (Licence: NY 54964) | |
| 363LF0000X Nurse Practitioner Family (Licence: NY 54964) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: NY 54964) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2012-03-28 |