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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)
(513) 402-4333
Entity
Organization

Contact information

Practice address
677 MAIN STREET, MARGARETVILLE, NY 12455
(845) 586-2651
Mailing address
44 HOLLAND AVENUE, ALBANY, NY 12229-0001
(518) 402-4333

Taxonomy

Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
00233170
NY

Other

Enumeration date
07/31/2009
Last updated
01/06/2016
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