Provider Demographics
NPI:1902951783
Name:BOARD OF EDUCATION DIST 1
Entity Type:Organization
Organization Name:BOARD OF EDUCATION DIST 1
Other - Org Name:EDINBURG COMMON SCHOOL TOWN OF EDINBURG
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-863-6375
Mailing Address - Street 1:4 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12134-5313
Mailing Address - Country:US
Mailing Address - Phone:518-863-6375
Mailing Address - Fax:518-863-2564
Practice Address - Street 1:4 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:NY
Practice Address - Zip Code:12134-5313
Practice Address - Country:US
Practice Address - Phone:518-863-8412
Practice Address - Fax:518-863-2564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01693154Medicaid