Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2025-03-21
- Last updated
- 2025-03-21
Specialties
Licenses
The registry row did not include a license.
Location
- Practice location
- 10 GRANDVIEW AVENUE
- City
- CATSKILL NY
- Postal code
- 12414
- Phone
- 518-943-9100
Organization contact
- Name
- MARY LOU STAIB
- Title
- provider enrollment specialist
- Phone
- 5186973258
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.