Organization
STATE OF NEW YORK COMPTROLLERS OFFICE
Active
Parent organization
STATE OF NEW YORK COMPTROLLERS OFFICE
Other names
Broome DDSO - Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF NEW YORK COMPTROLLERS OFFICE
Authorized official
EARL JEFFERSON (DIRECTOR OF CENTRAL OPERATIONS)
(518) 402-4333
Entity
Organization
Contact information
Practice address
119 KEMPER LN, NORWICH, NY 13815-3579
(607) 334-3577
Mailing address
44 HOLLAND AVE, ALBANY, NY 12229-0001
(518) 402-4333
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
00233170
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01419121
—
NY
Enumeration date
03/16/2007
Last updated
01/06/2016
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