1306100235 NPI number — MISS ELSIE SHEGBONE SPECIAL EDUCATION

Table of content: MISS ELSIE SHEGBONE SPECIAL EDUCATION (NPI 1306100235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306100235 NPI number — MISS ELSIE SHEGBONE SPECIAL EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEGBONE
Provider First Name:
ELSIE
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
SPECIAL EDUCATION
Provider Gender Code:
F

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:
1306100235
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 RALSTON WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08831-2901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-521-4215
Provider Business Mailing Address Fax Number:
732-521-4215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8866 MYRTLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11385-7857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-850-0400
Provider Business Practice Location Address Fax Number:
718-850-4441
Provider Enumeration Date:
06/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  759736971 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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