MEDICARE: FORT LEE 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)		NJ

General Provider Information

NPI Number	:	1790158483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT LEE BOARD OF EDUCATION

Provider Business Mailing Address
First Line	:	2175 LEMOINE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6008
Country	:	US
Telephone Number	:	201-585-4612
Fax Number	:	201-585-7997

Provider Business Practice Location Address
First Line	:	2175 LEMOINE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6008
Country	:	US
Telephone Number	:	201-585-4612
Fax Number	:	201-585-7997

Authorized Official
Title or Position	:	INTERIM BUSINESS ADMINISTRATOR
Name	:	H. RONALD SMITH
Credential	:
Telephone Number	:	201-585-4612

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	11/04/2015

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