Provider Demographics
NPI:1891152724
Name:NEW YORK STATE OPWDD
Entity Type:Organization
Organization Name:NEW YORK STATE OPWDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTORY, CNY DDSO
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-473-6979
Mailing Address - Street 1:65 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13316-1339
Mailing Address - Country:US
Mailing Address - Phone:315-245-4121
Mailing Address - Fax:315-245-4526
Practice Address - Street 1:65 MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13316-1339
Practice Address - Country:US
Practice Address - Phone:315-245-4121
Practice Address - Fax:315-245-4526
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CNYDDSO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225X00000X251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable