Provider Demographics
NPI:1629024559
Name:CITY OF NEW YORK OFFICE OF PAYROLL ADMINISTRATION
Entity type:Organization
Organization Name:CITY OF NEW YORK OFFICE OF PAYROLL ADMINISTRATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-396-4853
Mailing Address - Street 1:42-09 28TH STREET CN-48
Mailing Address - Street 2:
Mailing Address - City:LIC
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4132
Mailing Address - Country:US
Mailing Address - Phone:347-396-4853
Mailing Address - Fax:347-396-6367
Practice Address - Street 1:455 FIRST AVENUE
Practice Address - Street 2:NYCDOHMH BUREAU OF LABORATORIES
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4006
Practice Address - Country:US
Practice Address - Phone:212-447-2578
Practice Address - Fax:212-447-2587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D0679872291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01390234Medicaid