| NPI | 1912545344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK OLDENDORF Owner 518-435-1300 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2019-12-17 |