Healthcare Provider Details

I. General information

NPI: 1356286124
Provider Name (Legal Business Name): STATE OF NEW YORK COMPTROLLERS OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 WILLOWBROOK RD BLDG 15L
STATEN ISLAND NY
10314-4209
US

IV. Provider business mailing address

44 HOLLAND AVE
ALBANY NY
12208-3411
US

V. Phone/Fax

Practice location:
  • Phone: 718-983-5369
  • Fax:
Mailing address:
  • Phone: 518-402-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

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