Healthcare Provider Details

I. General information

NPI: 1578233003
Provider Name (Legal Business Name): STATE OF NEW YORK COMPTROLLERS OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BALLTOWN RD
SCHENECTADY NY
12304-2247
US

IV. Provider business mailing address

44 HOLLAND AVE
ALBANY NY
12208-3411
US

V. Phone/Fax

Practice location:
  • Phone: 518-654-7650
  • Fax:
Mailing address:
  • Phone: 518-402-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: EARL RAYMOND JEFFERSON
Title or Position: DIRECTOR OF CENTRAL OPERATIONS
Credential:
Phone: 518-402-4333