MEDICARE: ANSONIA PUBLIC SCHOOL DISTRICT, ANSONIA 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)		CT

General Provider Information

NPI Number	:	1801957899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANSONIA PUBLIC SCHOOL DISTRICT, ANSONIA BOARD OF EDUCATION

Provider Business Mailing Address
First Line	:	42 GROVE ST
Second Line	:
City	:	ANSONIA
State	:	CT
Zip	:	06401-1753
Country	:	US
Telephone Number	:	203-736-5095
Fax Number	:	203-736-5098

Provider Business Practice Location Address
First Line	:	42 GROVE ST
Second Line	:
City	:	ANSONIA
State	:	CT
Zip	:	06401-1753
Country	:	US
Telephone Number	:	203-736-5095
Fax Number	:	203-736-5098

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	DR. ED FAVOLISE
Credential	:
Telephone Number	:	203-736-5095

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/22/2020

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