NPIMap

Organization Active NPI

State of New York Comptrollers Office

  • Developmental Disabilities Clinic/Center
  • Newark, NY
National Provider Identifier
1013057892
Registry record updated Jan 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
License
00272950 Issued in NY
Legal business name
STATE OF NEW YORK COMPTROLLERS OFFICE
Practice address
703 E Maple Ave
Tymeson BLDG
Newark, NY 14513-1845
Phone
(315) 331-1700
NPI assigned
Feb 8, 2007
Organization subpart
Yes
Parent organization
STATE OF NEW YORK COMPTROLLERS OFFICEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 6, 2016

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Disabilities Clinic/Center 261QD1600X 00272950 NY Primary

Addresses

Primary practice location

703 E Maple Ave
Tymeson BLDG
Newark, NY 14513-1845

Mailing address

44 Holland Ave
Albany, NY 12229-0001
Phone (518) 402-4333

Other identifiers 1

IdentifierTypeStateIssuer
01433807MedicaidNY

Other names 1

  • Finger Lakes DDSO - Newark Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040313000077 NY Part B Supplier - Clinic/Group Practice 0840101770 Receives reassigned benefits from 65 practitioners
36 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stony Brook, NY; West Haverstraw, NY

Other NPIs on the same Medicare enrollment 36

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 36

National Provider Directory

National Provider Directory
Part of
Daniel a Spengler

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452038400000",
    "number": "1013057892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 HOLLAND AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122290001",
            "telephone_number": "518-402-4333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 E MAPLE AVE",
            "address_2": "TYMESON BLDG",
            "city": "NEWARK",
            "state": "NY",
            "postal_code": "145131845",
            "telephone_number": "315-331-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF NEW YORK COMPTROLLERS OFFICE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF NEW YORK COMPTROLLERS OFFICE",
        "enumeration_date": "2007-02-08",
        "last_updated": "2016-01-06",
        "status": "A",
        "authorized_official_last_name": "JEFFERSON",
        "authorized_official_first_name": "EARL",
        "authorized_official_title_or_position": "DIRECTOR OF CENTRAL OPERATIONS",
        "authorized_official_telephone_number": "518-402-4333"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NY",
            "license": "00272950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01433807",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Finger Lakes DDSO - Newark",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Newark, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.