NPIMap

Organization Active NPI

State of New York Comptrollers Office

Doing business as SUNY Fredonia/Youngerman Center for Communication Disorders

  • Audiologist
  • Fredonia, NY
National Provider Identifier
1508079567
Registry record updated Nov 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Legal business name
STATE OF NEW YORK COMPTROLLERS OFFICE
Practice address
280 Central Ave
W123 Thompson Hall
Fredonia, NY 14063-1127
Phone
(716) 673-3203
Fax
(716) 673-3235
NPI assigned
May 7, 2007
Last updated
Nov 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2018

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

Authorized official

Name
Michael D Metzger
Title
VP Finance & Admin
Phone
(716) 673-3109

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
AudiologistGroup: 193200000X MULTI-SPECIALTY GROUP 231H00000X Primary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

280 Central Ave
W123 Thompson Hall
Fredonia, NY 14063-1127

Mailing address

280 Central Ave
W123 Thompson Hall
Fredonia, NY 14063-1127
Phone (716) 673-3203

Other names 1

  • SUNY Fredonia/Youngerman Center for Communication Disorders Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040304000126 NY Part B Supplier - Clinic/Group Practice 0840101770 Receives reassigned benefits from 7 practitioners
Practice locations: Fredonia, NY

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Monroe Ddso Clinic University269 organizations share this tax ID, including this one

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

Locations

280 Central Ave
#123
Fredonia, NY 14063

280 Central Ave
#W123
Fredonia, NY 14063
Phone (716) 673-3202

4334 County Road 32
Oxford, NY 13830

Ownership & related parties

All facility ownership & control disclosures 13

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Helen Hayes HospitalWest Haverstraw, NY, CCN 330405 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Suny Health Science Center at SyracuseSyracuse, NY, CCN 33S241 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Suny Health Science Center at SyracuseSyracuse, NY, CCN 33T241 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Helen Hayes HospitalWest Haverstraw, NY, CCN 33T405 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
University Hospital of Brooklyn Suny Downstate Health Sciences UniversBrooklyn, NY, CCN 330350 Hospital 5% Or Greater Indirect Ownership Interest Dec 22, 1966
University Hospital of Brooklyn Suny Downstate Health Sciences UniversBrooklyn, NY, CCN 33T350 Hospital 5% Or Greater Indirect Ownership Interest Dec 22, 1966
Nys Veterans Home at MontroseMontrose, NY, CCN 335832 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Sep 11, 2001
Long Island State Veterans HomeStony Brook, NY, CCN 335758 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF
Direct Ownership Interest (100%)		 Oct 23, 1991
Oct 23, 1991
Oct 23, 1991
New York Veterans Home at BataviaBatavia, NY, CCN 335788 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)
Adp of the SNF		 Apr 1, 1995
Apr 1, 1995
Apr 1, 1995
New York State Veterans HomeOxford, NY, CCN 335097 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)
Adp of the SNF		 Apr 1, 1971
Apr 1, 1971
Apr 1, 1971
Nys Veterans Home at St. AlbansJamaica, NY, CCN 335770 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Dec 31, 1993
Sep 24, 2009
Helen Hayes HospitalWest Haverstraw, NY, CCN 335873 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Apr 14, 2016
Aug 10, 2016
Aug 10, 2016
Helen Hayes Hospital RHCFWest Haverstraw, NY, CCN 335823 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 13

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 13

Practitioners & affiliated clinicians

Practitioners 9

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": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542326400000",
    "number": "1508079567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 CENTRAL AVE",
            "address_2": "W123 THOMPSON HALL",
            "city": "FREDONIA",
            "state": "NY",
            "postal_code": "140631127",
            "telephone_number": "716-673-3203",
            "fax_number": "716-673-3235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 CENTRAL AVE",
            "address_2": "W123 THOMPSON HALL",
            "city": "FREDONIA",
            "state": "NY",
            "postal_code": "140631127",
            "telephone_number": "716-673-3203",
            "fax_number": "716-673-3235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF NEW YORK COMPTROLLERS OFFICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2018-11-16",
        "status": "A",
        "authorized_official_last_name": "METZGER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VP FINANCE & ADMIN",
        "authorized_official_telephone_number": "716-673-3109"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUNY Fredonia/Youngerman Center for Communication Disorders",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SUNY Fredonia/Youngerman Center for Communication Disorders",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fredonia, NY

Sources for this page

Verify at the official NPI Registry.