STATE OF NEW YORK NPI 1013056712

NPI Information

NPI: 1013056712
Provider Name: STATE OF NEW YORK

Other Name: STATEN ISLAND DDSO

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization

CLIA Number: 33D2272082

Address:
777 SEAVIEW AVE
STATEN ISLAND, NY
ZIP 10314
Phone: (518) 402-4333
Get Directions

STATE OF NEW YORK is an intermediate care facility mentally retarded in Staten Island, NY. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. STATE OF NEW YORK NPI is 1013056712. The provider is registered as an organization entity type.
The provider Other Name Is Staten Island Ddso.

The provider's business location address is:

777 SEAVIEW AVE
STATEN ISLAND, NY
ZIP 10314
Phone: (518) 402-4333

The provider's authorized official is Karla Smith .
The authorized official title is Director Of Central Operations and has the following contact phone number (518) 402-4333.

The CLIA number assigned to this NPI record is 33D2272082 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 2/6/2007 and was last updated on 6/25/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		OMRDD276	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00665843	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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