Active NPI
Plattsburgh State Tbi
- Case Management Agency
- Plattsburgh, NY
National Provider Identifier
1578623575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Management Agency
- Legal business name
- PLATTSBURGH STATE TBI
- Practice address
- 101 Broad St
Psychology Dept
Plattsburgh, NY 12901-2637 - Phone
- (518) 564-3137
- Fax
- (518) 564-3397
- NPI assigned
- Dec 11, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jeanne P. Ryan, PH.D.
- Title
- Executive Director
- Phone
- (518) 564-3387
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | Primary |
Addresses
Primary practice location
101 Broad St
Psychology Dept
Plattsburgh, NY 12901-2637
Mailing address
101 Broad St
Psychology Dept
Plattsburgh, NY 12901-2637
Phone (518) 564-3137
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01783797 | Medicaid | NY |
National Provider Directory
National Provider Directory- Tax ID family
- North Country Regional Tbi Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba North Country Regional TBI Center
- Clinical Neuropsychologist
- Plattsburgh, NY
- NPI 1982971941
Locations
101 Broad St
Plattsburgh, NY 12901
Phone (518) 564-2170
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1578623575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 BROAD ST",
"address_2": "PSYCHOLOGY DEPT",
"city": "PLATTSBURGH",
"state": "NY",
"postal_code": "129012637",
"telephone_number": "518-564-3137",
"fax_number": "518-564-3397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 BROAD ST",
"address_2": "PSYCHOLOGY DEPT",
"city": "PLATTSBURGH",
"state": "NY",
"postal_code": "129012637",
"telephone_number": "518-564-3137",
"fax_number": "518-564-3397"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PLATTSBURGH STATE TBI",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-11",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "RYAN",
"authorized_official_first_name": "JEANNE",
"authorized_official_middle_name": "P.",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "518-564-3387",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PH.D."
},
"taxonomies": [
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01783797",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Plattsburgh, NY
- Plattsburgh Oral Surgery PC
- Plattsburgh Otolaryngology-Head and Neck Surgery, PLLC
- Plattsburgh Pediatrics PC
- Plattsburgh Podiatry Center LLP
- Plattsburgh Sports Medicine, PLLC
- Plattsburgh State University (North Country Regional TBI Center)
- Plattsburgh State University Speech and Hearing Center (SUNY Plattsburgh Speech & Hearing Center)
- Teresa Shine Plimpton, R.N.
- Karen Plotas-McGrath, PHN
- Jennifer Nurit Plotnick, D.M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.