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NPI Code Detail

MEDICARE: STATE OF NEW YORK

MEDICARE: STATE OF NEW YORK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1315P00000XIntellectual Disabilities Intermediate Care Facility00229615NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255471462
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATE OF NEW YORK
Provider Business Mailing Address
First Line : 44 HOLLAND AVE
Second Line :
City : ALBANY
State : NY
Zip : 12229-0001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1478 E AND WEST RD
Second Line :
City : BUFFALO
State : NY
Zip : 14224-3702
Country : US
Telephone Number : 518-402-4333
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF CENTRAL OPERATIONS
Name : KARLA SMITH
Credential :
Telephone Number : 518-402-4333
Provider Enumeration Date : 02/07/2007
Last Update Date : 06/26/2008

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Directions to “STATE OF NEW YORK ” Practice Location

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