Healthcare Provider Details

I. General information

NPI: 1619034154
Provider Name (Legal Business Name): NYS OFFICE OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WATERS PL
BRONX NY
10461-2723
US

IV. Provider business mailing address

44 HOLLAND AVE
ALBANY NY
12229-0001
US

V. Phone/Fax

Practice location:
  • Phone: 718-931-0600
  • Fax:
Mailing address:
  • Phone: 518-473-8234
  • Fax: 518-473-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateNY

VIII. Authorized Official

Name: ROBERT PUCCIO
Title or Position: DIRECTOR FINANCE
Credential:
Phone: 518-473-0795