Provider Demographics
NPI:1407028350
Name:EPILEPSY FOUNDATION OF NENY INC
Entity Type:Organization
Organization Name:EPILEPSY FOUNDATION OF NENY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:GARAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-456-7501
Mailing Address - Street 1:3 WASHINGTON SQUARE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205
Mailing Address - Country:US
Mailing Address - Phone:518-456-7501
Mailing Address - Fax:518-452-1282
Practice Address - Street 1:3 WASHINGTON SQUARE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-456-7501
Practice Address - Fax:518-452-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01636988Medicaid
NY02281285Medicaid
NY01998503Medicaid
NY01905068Medicaid