NPIMap

Organization Active NPI

State of New York

  • Intellectual Disabilities Intermediate Care Facility
  • Queens Village, NY
National Provider Identifier
1003447012
Registry record updated Jan 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
STATE OF NEW YORK
Practice address
8045 Winchester Blvd BLDG 08
Queens Village, NY 11427-2194
Phone
(718) 217-4242
NPI assigned
Jan 29, 2020
Organization subpart
Yes
Parent organization
STATE OF NEW YORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 29, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Earl Raymond Jefferson
Title
Director of Central Operations
Phone
(518) 402-4333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

8045 Winchester Blvd BLDG 08
Queens Village, NY 11427-2194

Mailing address

44 Holland Ave FL 4
Albany, NY 12208-3411
Phone (518) 402-4333

Other names 1

  • Bernard Fineson DDSO Other name

National Provider Directory

National Provider Directory
Tax ID family
Daniel a Spengler269 organizations share this tax ID, including this one
Part of
Daniel a Spengler

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580256000000",
    "number": "1003447012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 HOLLAND AVE FL 4",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122083411",
            "telephone_number": "518-402-4333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8045 WINCHESTER BLVD BLDG 08",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114272194",
            "telephone_number": "718-217-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF NEW YORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF NEW YORK",
        "enumeration_date": "2020-01-29",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A",
        "authorized_official_last_name": "JEFFERSON",
        "authorized_official_first_name": "EARL",
        "authorized_official_middle_name": "RAYMOND",
        "authorized_official_title_or_position": "DIRECTOR OF CENTRAL OPERATIONS",
        "authorized_official_telephone_number": "518-402-4333"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bernard Fineson DDSO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Queens Village, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.