Provider Demographics
NPI:1952461956
Name:SUNY PLATTSBURGH NYSACAC DAY
Entity Type:Organization
Organization Name:SUNY PLATTSBURGH NYSACAC DAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ZANDI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-564-3377
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:2006-12-11
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02703542Medicaid