Provider Demographics
NPI:1790449726
Name:NYS DOCCS WENDE CORRECTIONEL FACILITY
Entity Type:Organization
Organization Name:NYS DOCCS WENDE CORRECTIONEL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:HEAD ADMINISTRATOR
Authorized Official - Phone:716-937-4000
Mailing Address - Street 1:3622 WENDE RD
Mailing Address - Street 2:PO BOX 1187
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-1187
Mailing Address - Country:US
Mailing Address - Phone:716-937-4000
Mailing Address - Fax:
Practice Address - Street 1:3622 WENDE RD
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-1187
Practice Address - Country:US
Practice Address - Phone:716-937-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW YORK STATE DEPT OF CORRECTIONS & COMMUNITY SUPERVISION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3379030OtherNABP