Provider Demographics
NPI:1861551798
Name:STATE OF NEW YORK COMPTROLLERS OFFICE
Entity type:Organization
Organization Name:STATE OF NEW YORK COMPTROLLERS OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DEAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHEL
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:716-829-2336
Mailing Address - Street 1:325 SQUIRE HALL
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-8006
Mailing Address - Country:US
Mailing Address - Phone:716-829-2836
Mailing Address - Fax:716-833-3517
Practice Address - Street 1:108A SQUIRE HALL
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-3008
Practice Address - Country:US
Practice Address - Phone:716-829-2836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1401226R261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01712734Medicaid