| NPI | 1912066242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEN BAUTISTA DATOR Physician 315-343-2151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 2300280) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2008-05-20 |