MEDICARE: MAHOPAC CENTRAL SCHOOL DISTRICT

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)	491468-1	NY

General Provider Information

NPI Number	:	1518240712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHOPAC CENTRAL SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	100 MYRTLE AVE
Second Line	:
City	:	MAHOPAC
State	:	NY
Zip	:	10541-4641
Country	:	US
Telephone Number	:	845-621-0656
Fax Number	:	845-621-0380

Provider Business Practice Location Address
First Line	:	100 MYRTLE AVE
Second Line	:
City	:	MAHOPAC
State	:	NY
Zip	:	10541-4641
Country	:	US
Telephone Number	:	845-621-0656
Fax Number	:	845-621-0380

Authorized Official
Title or Position	:	SCHOOL NURSE
Name	:	MRS. JILL BETH TALCOVITZ
Credential	:	R.N.
Telephone Number	:	845-621-0656

Provider Enumeration Date	:	09/23/2011
Last Update Date	:	09/23/2011

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