Provider Demographics
NPI:1972718708
Name:RESEARCH FOUNDATION OF STATE UNIVERSITY OF N.Y.
Entity Type:Organization
Organization Name:RESEARCH FOUNDATION OF STATE UNIVERSITY OF N.Y.
Other - Org Name:ALZHEIMER'S DISEASE ASSISTANCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, SPONSORED RESEARCH & PROG
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-564-2155
Mailing Address - Street 1:101 BROAD ST.
Mailing Address - Street 2:SIBLEY 227
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2681
Mailing Address - Country:US
Mailing Address - Phone:518-564-3377
Mailing Address - Fax:518-564-2328
Practice Address - Street 1:101 BROAD ST.
Practice Address - Street 2:SIBLEY HALL 227
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2681
Practice Address - Country:US
Practice Address - Phone:518-564-3377
Practice Address - Fax:518-564-2328
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESEARCH FOUNDATION OF STATE UNIVERSITY OF N.Y.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-14
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015955103TC0700X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1515Medicare PIN
NYX85671Medicare UPIN