Organization
STATE OF NEW YORK COMPTROLLERS OFFICE
Active
Parent organization
STATE OF NEW YORK COMPTROLLERS OFFICE
Other names
IBR George A Jervis 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
1050 FOREST HILL RD, STATEN ISLAND, NY 10314-6356
(718) 494-5151
(718) 494-2258
Mailing address
44 HOLLAND AVENUE, ALBANY, NY 12229-0001
(518) 402-4333
(518) 473-1874
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
224141
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00869952
—
NY
01
—
224141
OMRDD OPERATING CERT #
NY
Enumeration date
11/02/2006
Last updated
12/28/2015
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