MEDICARE: VENTNOR BOARD OF EDUCATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1245617612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VENTNOR BOARD OF EDUCATION

Provider Business Mailing Address
First Line	:	400 N LAFAYETTE AVE
Second Line	:
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-1026
Country	:	US
Telephone Number	:	609-487-7900
Fax Number	:	609-822-0150

Provider Business Practice Location Address
First Line	:	400 N LAFAYETTE AVE
Second Line	:
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-1026
Country	:	US
Telephone Number	:	609-487-7900
Fax Number	:	609-822-0150

Authorized Official
Title or Position	:	BUSINESS ADMINISTRATOR
Name	:	TERRI NOWOTNY
Credential	:
Telephone Number	:	609-487-7900

Provider Enumeration Date	:	05/05/2015
Last Update Date	:	05/05/2015

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