1306114392 NPI number — THREE VILLAGE CENTRAL SCHOOL DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306114392 NPI number — THREE VILLAGE CENTRAL SCHOOL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THREE VILLAGE CENTRAL SCHOOL DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306114392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
172 HULSE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WADING RIVER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11792-1956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-848-0165
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SETAUKET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11733-2833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-730-4600
Provider Business Practice Location Address Fax Number:
631-730-4604
Provider Enumeration Date:
12/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DEVORE
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR, PUPIL PERSONNEL
Authorized Official Telephone Number:
631-730-4574

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  012429-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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