| NPI | 1992276885 |
|---|---|
| Other Name | HQMP POUGH. VASC. SURG. |
| Entity Type | Organization |
| Authorized Contact | GLENN LOOMIS Cmo 845-475-9661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2018-12-17 |