| NPI | 1972760759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN BRAY Executive Director 845-871-0009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: NY 104100000x) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2008-05-20 |