New York State Opwdd

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

License

225X00000X Issued in NY

Legal business name

NEW YORK STATE OPWDD

Practice address

65 Main St
Camden, NY 13316-1339

Phone

(315) 245-4121

Fax

(315) 245-4526

NPI assigned

Jan 22, 2016

Last updated

Jan 22, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

CNYDDSOAs reported in NPPES

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

Authorized official

Name

Lynette O'Brien

Title

Deputy Directory, Cny Ddso

Phone

(315) 473-6979

Specialties & licenses 1

Addresses

Part of

Wilton Devel Ctr Rev M

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Cnyddso

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Rome, NY
  • NPI 1356700488
  NPPES parent name

Practitioners 1

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.

• Susan Richards

  • Occupational Therapist
  • Camden, NY
  • NPI 1194183103
  NPD (past)

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

{
    "created_epoch": "1453420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453420800000",
    "number": "1891152724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 MAIN ST",
            "city": "CAMDEN",
            "state": "NY",
            "postal_code": "133161339",
            "telephone_number": "315-245-4121",
            "fax_number": "315-245-4526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 MAIN ST",
            "city": "CAMDEN",
            "state": "NY",
            "postal_code": "133161339",
            "telephone_number": "315-245-4121",
            "fax_number": "315-245-4526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW YORK STATE OPWDD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CNYDDSO",
        "enumeration_date": "2016-01-22",
        "last_updated": "2016-01-22",
        "status": "A",
        "authorized_official_last_name": "O'BRIEN",
        "authorized_official_first_name": "LYNETTE",
        "authorized_official_title_or_position": "DEPUTY DIRECTORY, CNY DDSO",
        "authorized_official_telephone_number": "315-473-6979"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "NY",
            "license": "225X00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn E Miranda, LPN
• Rebecca Lynn Mix, RN
• Virinder Modgil, DDS
• Mitchell Paul Morgan, DPT
• Abby Gail Mumford, OTR/L
• Julie Ann Noti, LCSW
• Buffy Jo Olson, LPN
• Gregory Paradis, P.T.
• Robin Marie Pardee, LPN
• Jessica Marie Perusse, LCSW

• Voluntary or Charitable Agency in Camden, NY
• Providers in Camden, NY by specialty
• Voluntary or Charitable Agency in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2016; 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.