State of New York

NPI #1427198829 in Ridge, New York

Provider Information

NPI Number: 1427198829
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: Feb 7, 2007
Last Updated: Jun 26, 2008

Practice Location

Address: 64 RIDGE RD
Address 2: HOUSE A
City: Ridge
State: New York
ZIP Code: 11961-1008
Phone: (518) 402-4333

Authorized Official

Name: KARLA SMITH
Title: DIRECTOR OF CENTRAL OPERATIONS
Phone: (518) 402-4333

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Intermediate Care Facility, Intellectual Disabilities	315P00000X	Primary

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