Healthcare Provider Details

I. General information

NPI: 1235142472
Provider Name (Legal Business Name): STATE OF NEW YORK COMPTROLLERS OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 9W
WEST HAVERSTRAW NY
10993-1127
US

IV. Provider business mailing address

ROUTE 9W
WEST HAVERSTRAW NY
10993-1127
US

V. Phone/Fax

Practice location:
  • Phone: 845-786-4000
  • Fax: 845-947-0036
Mailing address:
  • Phone: 845-786-4000
  • Fax: 845-947-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number4322000H
License Number StateNY

VIII. Authorized Official

Name: EDMUND COLETTI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 845-786-4305