=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275740375
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STATE OF NEW YORK COMPTROLLERS OFFICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 01/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 178-50 LINDEN BLVD
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11434-1467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-990-0329
-----------------------------------------------------
Fax | 718-481-6860
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 178-50 LINDEN BLVD
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11434-1467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-990-0329
-----------------------------------------------------
Fax | 718-481-6860
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEALTH PROGRAM ADMINISTRATOR
-----------------------------------------------------
Name | MS. KAREN CALLY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 518-474-2772
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 7003383N
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------