| NPI | 1962622977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WHALEN Director Of Administration 518-435-2704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 54964) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NY 54964) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2012-03-28 |