Provider Demographics
NPI:1457348369
Name:STATE OF NEW YORK COMPTROLLERS OFFICE
Entity Type:Organization
Organization Name:STATE OF NEW YORK COMPTROLLERS OFFICE
Other - Org Name:NYS VETERANS HOME AT MONTROSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAA-DANSO
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATION
Authorized Official - Phone:914-788-6003
Mailing Address - Street 1:4334 COUNTY ROAD 32
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13830-4101
Mailing Address - Country:US
Mailing Address - Phone:914-788-6000
Mailing Address - Fax:914-788-6110
Practice Address - Street 1:2090 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548-1454
Practice Address - Country:US
Practice Address - Phone:914-788-6000
Practice Address - Fax:914-788-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5951300N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02210915Medicaid
NYW39391OtherMEDICARE PTAN
NYW39391OtherMEDICARE PTAN
NYW39391Medicare PIN
NY335832Medicare ID - Type Unspecified