Provider Demographics
NPI:1053880906
Name:NYS OPWDD
Entity type:Organization
Organization Name:NYS OPWDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BYRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD/DO
Authorized Official - Phone:518-788-2693
Mailing Address - Street 1:200 SMITH DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:NY
Mailing Address - Zip Code:12822
Mailing Address - Country:US
Mailing Address - Phone:518-654-7680
Mailing Address - Fax:518-654-7695
Practice Address - Street 1:200 SMITH DRIVE
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:NY
Practice Address - Zip Code:12822
Practice Address - Country:US
Practice Address - Phone:518-654-7680
Practice Address - Fax:518-654-7695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty