Provider Demographics
NPI:1902297641
Name:STATE UNIVERSITY OF NEW YORK AT ALBANY
Entity Type:Organization
Organization Name:STATE UNIVERSITY OF NEW YORK AT ALBANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UNIVERSITY CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-956-8095
Mailing Address - Street 1:1400 WASHINGTON AVE
Mailing Address - Street 2:STUDENT HEALTH SERVICES
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12222
Mailing Address - Country:US
Mailing Address - Phone:518-442-5463
Mailing Address - Fax:518-442-5444
Practice Address - Street 1:1400 WASHINGTON AVE
Practice Address - Street 2:STUDENT HEALTH SERVICES
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12222
Practice Address - Country:US
Practice Address - Phone:518-442-5463
Practice Address - Fax:518-442-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022074333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy