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General NPI Number Information
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NPI Number | 1568646941
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Entity Type | Organization
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Legal Business Name | NEW YORK STATE
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 75 MORTON ST
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City | NEW YORK
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State | NY
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Zip | 10014-5750
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Country | US
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Telephone | 518-457-9835
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Fax |
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Provider Business Mailing Address
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Address Line | 44 HOLLAND AVE
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City | ALBANY
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State | NY
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Zip | 12229-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CENTRAL OPERATIONS
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Name | KARLA SMITH
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Credential |
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Telephone | 518-402-4333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | CAH00068
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License Number State | NY
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