| NPI | 1942660105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA CONNORS Credentialing Specialist 518-465-4771 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2022-07-21 |