Healthcare Provider Details

I. General information

NPI: 1659317741
Provider Name (Legal Business Name): STATE OF NEW YORK COMPTROLLERS OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PATRIOTS RD
STONY BROOK NY
11790-3318
US

IV. Provider business mailing address

100 PATRIOTS RD
STONY BROOK NY
11790-3318
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-8646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number021131
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAT D ROCCO
Title or Position: CFO
Credential:
Phone: 631-444-8646