Provider Demographics
NPI:1053482067
Name:STATE OF NEW YORK COMPTROLLERS OFFICE
Entity type:Organization
Organization Name:STATE OF NEW YORK COMPTROLLERS OFFICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST. DEAN CLINIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-632-8966
Mailing Address - Street 1:184D NICHOLS ROAD SULLIVAN HALL
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-632-8966
Mailing Address - Fax:631-632-9302
Practice Address - Street 1:184D NICHOLS ROAD SULLIVAN HALL
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794
Practice Address - Country:US
Practice Address - Phone:631-632-8966
Practice Address - Fax:631-632-9302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF NEW YORK COMPTROLLERS OFFICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-13
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY377821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00475076Medicaid