State of New York
NPI #1003447012 in Queens Village, New York
Provider Information
- NPI Number
- 1003447012
- Entity Type
- Organization
- Organization Name
- State of New York
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- STATE OF NEW YORK
- Primary Specialty
- Intermediate Care Facility, Intellectual Disabilities
- Enumeration Date
- Jan 29, 2020
- Last Updated
- Jan 29, 2020
Practice Location
- Address
- 8045 WINCHESTER BLVD BLDG 08
- City
- Queens Village
- State
- New York
- ZIP Code
- 11427-2194
- Phone
- (718) 217-4242
Authorized Official
- Name
- EARL RAYMOND JEFFERSON
- Title
- DIRECTOR OF CENTRAL OPERATIONS
- Phone
- (518) 402-4333
Specialties & Taxonomy Codes
| Specialty |
|---|
| Intermediate Care Facility, Intellectual Disabilities |
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