1396863692 NPI number — NEW MILFORD PUBLIC SCHOOL

Table of content: (NPI 1023293784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396863692 NPI number — NEW MILFORD PUBLIC SCHOOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW MILFORD PUBLIC SCHOOL
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:
1396863692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/03/2008
NPI Reactivation Date:
05/09/2011

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 EAST ST
Provider Second Line Business Mailing Address:
OFFICE OF STUDENT AFFAIRS
Provider Business Mailing Address City Name:
NEW MILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06776-3030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-354-2654
Provider Business Mailing Address Fax Number:
860-210-2682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 SUNNY VALLEY RD
Provider Second Line Business Practice Location Address:
SARAH NOBLE INTERMEDIATE SCHOOL
Provider Business Practice Location Address City Name:
NEW MILFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06776-3333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-210-4020
Provider Business Practice Location Address Fax Number:
860-210-4030
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
ADELE
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
SUPERVISOR OF SPECIAL EDUCATION
Authorized Official Telephone Number:
860-354-2654

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004097657 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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