Organization
STATE OF NEW YORK
Active
Parent organization
STATE OF NEW YORK
Other names
CAH Staten Island DDSO
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF NEW YORK
Authorized official
KARLA SMITH (DIRECTOR OF CENTRAL OPERATIONS)
(518) 402-4333
Entity
Organization
Contact information
Practice address
1150 FOREST HILL RD, STATEN ISLAND, NY 10314-6316
(518) 457-9835
Mailing address
44 HOLLAND AVE, ALBANY, NY 12229-0001
(518) 402-4333
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
CAH00017
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01361173
—
NY
Enumeration date
01/03/2008
Last updated
06/25/2008
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