Provider Demographics
NPI:1407829856
Name:STATE OF NEW YORK COMPTROLLERS OFFICE
Entity type:Organization
Organization Name:STATE OF NEW YORK COMPTROLLERS OFFICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-938-5946
Mailing Address - Street 1:33 WEST 42ND STREET
Mailing Address - Street 2:CLINICAL ADMINISTRATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-8005
Mailing Address - Country:US
Mailing Address - Phone:212-938-5831
Mailing Address - Fax:
Practice Address - Street 1:33 WEST 42ND STREET
Practice Address - Street 2:CLINICAL ADMINISTRATION
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-8005
Practice Address - Country:US
Practice Address - Phone:212-938-4030
Practice Address - Fax:212-938-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCI7179OtherRAIL ROAD MEDICARE
NY00244528Medicaid
NY0380980004Medicare NSC
NYW01551Medicare PIN