NPIMap

Organization Active NPI

State of New York

  • Intellectual Disabilities Intermediate Care Facility
  • Queens Village, NY
National Provider Identifier
1356930820
Registry record updated Jan 11, 2021
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 8
Queens Village, NY 11427-2194
Phone
(718) 217-5767
NPI assigned
Jan 11, 2021
Last updated
Jan 11, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF NEW YORK COMPTROLLERS OFFICEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 11, 2021

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 NU Primary

Addresses

Primary practice location

8045 Winchester Blvd BLDG 8
Queens Village, NY 11427-2194

Mailing address

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

Other names 1

  • Bernard M. Fineson Developmental Disabilities Services Office Other name

National Provider Directory

National Provider Directory
Tax ID family
Wilton Devel Ctr Rev M269 organizations share this tax ID, including this one
Part of
Wilton Devel Ctr Rev M

Organizations with this tax ID in the same state 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1610323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610323200000",
    "number": "1356930820",
    "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": "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 8",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114272194",
            "telephone_number": "718-217-5767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF NEW YORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF NEW YORK COMPTROLLERS OFFICE",
        "enumeration_date": "2021-01-11",
        "last_updated": "2021-01-11",
        "certification_date": "2020-12-30",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bernard M. Fineson Developmental Disabilities Services Office",
            "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 11, 2021; 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.