Basic Information
Provider Information
NPI: 1063525442
EntityType: 2
ReplacementNPI:  
OrganizationName: STATE OF NEW YORK COMPTROLLERS OFFICE
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: HELEN HAYES HOSPITAL
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: ROUTE 9W
Address2:  
City: WEST HAVERSTRAW
State: NY
PostalCode: 109931127
CountryCode: US
TelephoneNumber: 8457864000
FaxNumber: 8459470036
Practice Location
Address1: ROUTE 9W
Address2:  
City: WEST HAVERSTRAW
State: NY
PostalCode: 109931127
CountryCode: US
TelephoneNumber: 8457864000
FaxNumber: 8459470036
Other Information
ProviderEnumerationDate: 08/17/2006
LastUpdateDate: 09/29/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: COLETTI
AuthorizedOfficialFirstName: EDMUND
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CHIEF EXECUTIVE OFFICER
AuthorizedOfficialTelephone: 8457864305
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: STATE OF NEW YORK COMPTROLLERS OFFICE
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X4322000HNYY HospitalsGeneral Acute Care Hospital 

ID Information
IDTypeStateIssuerDescription
H99901401NYOXFORDOTHER
0027395005NY MEDICAID
0047501NYBLUE CROSSOTHER
001411901NYAETNAOTHER


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