Provider Demographics
NPI:1508079567
Name:STATE OF NEW YORK COMPTROLLERS OFFICE
Entity Type:Organization
Organization Name:STATE OF NEW YORK COMPTROLLERS OFFICE
Other - Org Name:SUNY FREDONIA/YOUNGERMAN CENTER FOR COMMUNICATION DISORDERS
Other - Org Type:Other Name
Authorized Official - Title/Position:VP FINANCE & ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:METZGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-673-3109
Mailing Address - Street 1:280 CENTRAL AVE
Mailing Address - Street 2:W123 THOMPSON HALL
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1127
Mailing Address - Country:US
Mailing Address - Phone:716-673-3203
Mailing Address - Fax:716-673-3235
Practice Address - Street 1:280 CENTRAL AVE
Practice Address - Street 2:W123 THOMPSON HALL
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1127
Practice Address - Country:US
Practice Address - Phone:716-673-3203
Practice Address - Fax:716-673-3235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0086Medicare PIN