MEDICARE: WEYMOUTH TOWNSHIP 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	:	1780924530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEYMOUTH TOWNSHIP BOARD OF EDUCATION

Provider Business Mailing Address
First Line	:	1202 11TH AVE
Second Line	:
City	:	DOROTHY
State	:	NJ
Zip	:	08317-5511
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 11TH AVE
Second Line	:
City	:	DOROTHY
State	:	NJ
Zip	:	08317-5511
Country	:	US
Telephone Number	:	609-476-2412
Fax Number	:

Authorized Official
Title or Position	:	CHIEF SCHOOL ADMINISTRATOR
Name	:	DONNA VAN HORN
Credential	:
Telephone Number	:	609-476-2412

Provider Enumeration Date	:	02/15/2013
Last Update Date	:	02/15/2013

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