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General NPI Number Information
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NPI Number | 1508987348
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Entity Type | Organization
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Legal Business Name | STATE OF NEW YORK
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 51- 55 NORTH ROUTE 9W
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City | WEST HAVERSTRAW
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State | NY
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Zip | 10993-1195
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Country | US
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Telephone | 845-786-4202
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Fax | 845-947-0036
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Provider Business Mailing Address
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Address Line | 51-55 NORTH ROUTE 9W
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City | WEST HAVERSTRAW
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State | NY
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Zip | 10993-1195
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Country | US
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Telephone | 845-786-4202
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Fax | 845-947-0036
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Authorized Official
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Title or Position | CEO
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Name | MS. MAGDALENA RAMIREZ
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Credential |
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Telephone | 845-786-4202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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