STATE OF NEW YORK NPI 1003447012

Intermediate Care Facility, Mentally Retarded in Queens Village, NY

Organization Intermediate Care Facility, Mentally Ret...

About STATE OF NEW YORK

State Of New York is a provider established in Queens Village, New York specializing in intermediate care facility, mentally retarded. The NPI number of State Of New York is 1003447012 and was assigned on January 2020. The practitioner's primary taxonomy code is 315P00000X. The provider is registered as an organization and their NPI record was last updated January 2020. The authorized official of this NPI record is Earl Raymond Jefferson (Director Of Central Operations)

NPI

1003447012

Provider NameSTATE OF NEW YORK
Provider Location Address8045 WINCHESTER BLVD BLDG 08 QUEENS VILLAGE, NY 11427
Provider Mailing Address44 HOLLAND AVE FL 4 ALBANY, NY 12208
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?Yes
Enumeration Date01-29-2020
Last Update Date01-29-2020

Primary Taxonomy

Taxonomy Code315P00000X
ClassificationIntermediate Care Facility, Mentally Retarded
TypeNursing & Custodial Care Facilities
Taxonomy Description(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.

Business Address

STATE OF NEW YORK
8045 WINCHESTER BLVD BLDG 08
QUEENS VILLAGE, NY
ZIP 11427
Phone: (718) 217-4242

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Mailing Address

STATE OF NEW YORK
44 HOLLAND AVE FL 4
ALBANY, NY
ZIP 12208
Phone: (518) 402-4333

Authorized Official

Authorized Official Name EARL RAYMOND JEFFERSON
Authorized Official TitleDIRECTOR OF CENTRAL OPERATIONS
Authorized Official Phone(518) 402-4333

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.