Organization · Type 2 NPI

State of New York Comptrollers Office

Developmental Disabilities Clinic/Center · Elmira, NY

NPI number 1396195095 Active

Practice location

164 Sullivan Street
Elmira, NY 14901

Call (518) 402-4333 Map

Mailing address

44 Holland Ave
Albany, NY 12229

Specialties and licenses

Taxonomy	Code	License
Developmental Disabilities Clinic/Center Primary	261QD1600X	00232123 (NY)

Developmental Disabilities Clinic/Center: An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.).

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NPI record

NPI: 1396195095
Entity type: Organization (Type 2)
Issued: Jun 14, 2016
Last updated: Jun 14, 2016
Status: Active
Subpart: Yes of State of New York Comptrollers Office

Other names

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Finger Lakes Ddso-Sullivan · other name

Authorized official

Earl Jefferson
Director of Central Operations
(518) 402-4333

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1396195095

State of New York Comptrollers Office's National Provider Identifier is 1396195095, issued on Jun 14, 2016. The primary taxonomy on file is Developmental Disabilities Clinic/Center (261QD1600X), and the practice location is in Elmira, NY. The record was last updated on Jun 14, 2016.