NPIMap

Organization Active NPI

State of New York Comptrollers Office

  • Developmental Disabilities Clinic/Center
  • Kingston, NY
National Provider Identifier
1053445783
Registry record updated Dec 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
License
00275410 Issued in NY
Legal business name
STATE OF NEW YORK COMPTROLLERS OFFICE
Practice address
521 Boices LN
Kingston, NY 12401-1083
Phone
(845) 382-1899
NPI assigned
Mar 15, 2007
Organization subpart
Yes
Parent organization
STATE OF NEW YORK COMPTROLLERS OFFICEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 28, 2015

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 00275410 NY Primary

Addresses

Primary practice location

521 Boices LN
Kingston, NY 12401-1083

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
01399242MedicaidNY

Other names 1

  • Taconic DDSO 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
Monroe Ddso Clinic University

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451260800000",
    "number": "1053445783",
    "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": "521 BOICES LN",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124011083",
            "telephone_number": "845-382-1899"
        }
    ],
    "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": "2007-03-15",
        "last_updated": "2015-12-28",
        "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": "00275410",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01399242",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Taconic DDSO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kingston, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2015; 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.