| NPI | 1962963298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY TERK Credentialing Manager 518-525-5634 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2025-01-31 |