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General NPI Number Information
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NPI Number | 1891152724
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Entity Type | Organization
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Legal Business Name | NEW YORK STATE OPWDD
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Dates
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Enumeration Date | 01/22/2016
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 65 MAIN ST
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City | CAMDEN
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State | NY
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Zip | 13316-1339
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Country | US
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Telephone | 315-245-4121
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Fax | 315-245-4526
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Provider Business Mailing Address
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Address Line | 65 MAIN ST
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City | CAMDEN
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State | NY
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Zip | 13316-1339
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Country | US
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Telephone | 315-245-4121
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Fax | 315-245-4526
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Authorized Official
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Title or Position | DEPUTY DIRECTORY, CNY DDSO
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Name | LYNETTE O'BRIEN
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Credential |
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Telephone | 315-473-6979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 225X00000X
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License Number State | NY
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