STATE OF NEW YORK NPI 1356930820

NPI Information

STATE OF NEW YORK is an intermediate care facility mentally retarded in Queens Village, NY. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. STATE OF NEW YORK NPI is 1356930820. The provider is registered as an organization entity type.

The provider's business location address is:

8045 WINCHESTER BLVD BLDG 8
QUEENS VILLAGE, NY
ZIP 11427-194
Phone: (718) 217-5767

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

The enumeration date for this NPI number is 1/11/2021 and was last updated on 1/11/2021.

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:

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