Provider Demographics
NPI:1548325103
Name:EAST GREENBUSH CENTRAL SCHOOL DISTRICT
Entity type:Organization
Organization Name:EAST GREENBUSH CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:518-477-2756
Mailing Address - Street 1:29 ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-3900
Mailing Address - Country:US
Mailing Address - Phone:518-477-2756
Mailing Address - Fax:518-477-8124
Practice Address - Street 1:29 ENGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-3900
Practice Address - Country:US
Practice Address - Phone:518-477-2756
Practice Address - Fax:518-477-8124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========Medicaid