Provider Demographics
NPI:1346633989
Name:NYS DOCCS
Entity Type:Organization
Organization Name:NYS DOCCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY SUPT OF ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-639-5516
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:11739 STATE ROUTE 22
Mailing Address - City:COMSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12821-0051
Mailing Address - Country:US
Mailing Address - Phone:518-639-5516
Mailing Address - Fax:
Practice Address - Street 1:11739 STATE ROUTE 22
Practice Address - Street 2:GREAT MEADOW CORRECTIONAL FACILITY
Practice Address - City:COMSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12821-0051
Practice Address - Country:US
Practice Address - Phone:518-639-5516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000650-1311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility