Provider Demographics
NPI:1851453971
Name:SUNY PLATTSBURGH NYSADAC HCBS
Entity Type:Organization
Organization Name:SUNY PLATTSBURGH NYSADAC HCBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-564-3387
Mailing Address - Street 1:101 BROAD ST
Mailing Address - Street 2:SPONSORED RESEARCH
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2637
Mailing Address - Country:US
Mailing Address - Phone:518-564-3137
Mailing Address - Fax:518-564-3397
Practice Address - Street 1:101 BROAD ST
Practice Address - Street 2:SPONSORED RESEARCH
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2637
Practice Address - Country:US
Practice Address - Phone:518-564-3137
Practice Address - Fax:518-564-3397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01739362Medicaid