State of New York
NPI #1083899702 in Tupper Lake, New York
Provider Information
- NPI Number
- 1083899702
- Entity Type
- Organization
- Organization Name
- State of New York
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- STATE OF NEW YORK
- Primary Specialty
- Case Management
- Enumeration Date
- Dec 31, 2007
- Last Updated
- Jul 21, 2015
Practice Location
- Address
- 2445 STATE ROUTE 30
- City
- Tupper Lake
- State
- New York
- ZIP Code
- 12986-2502
- Phone
- (518) 457-9835
Authorized Official
- Name
- EARL JEFFERSON
- Title
- DIRECTOR OF CENTRAL OPERATIONS
- Phone
- (518) 402-4333
Specialties & Taxonomy Codes
| Specialty |
|---|
| Case Management |
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