1386851004 NPI number — STATE OF NEW YORK COMPTROLLERS OFFICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386851004 NPI number — STATE OF NEW YORK COMPTROLLERS OFFICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE OF NEW YORK COMPTROLLERS OFFICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NYS VETERANS HOME AT OXFORD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386851004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4207 STATE HIGHWAY 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13830-4305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-843-3129
Provider Business Mailing Address Fax Number:
607-843-3199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4207 STATE HIGHWAY 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13830-4305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-843-3129
Provider Business Practice Location Address Fax Number:
607-843-3199
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CALLY
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH PROGRAM ADMINISTRATOR
Authorized Official Telephone Number:
518-474-2772

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0825301N , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00474731 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: J100000360 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 810460 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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