Healthcare Provider Details

I. General information

NPI: 1871478511
Provider Name (Legal Business Name): STATE OF NEW YORK OFFICE OF STATE COMPTROLLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36560 STATE ROUTE 12E
CAPE VINCENT NY
13618-2122
US

IV. Provider business mailing address

1220 WASHINGTON AVE BLDG 4
ALBANY NY
12226-1799
US

V. Phone/Fax

Practice location:
  • Phone: 518-445-6176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: RYAN QUINN PENEYRA GUILARAN
Title or Position: DIRECTOR OF PHARMACY SERVICES
Credential:
Phone: 518-445-6176