Healthcare Provider Details

I. General information

NPI: 1083836480
Provider Name (Legal Business Name): BLAIRSTOWN ELEMENTARY SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SUNSET HILL RD.
BLAIRSTOWN NJ
07825
US

IV. Provider business mailing address

1 SUNSET HILL RD.
BLAIRSTOWN NJ
07825
US

V. Phone/Fax

Practice location:
  • Phone: 908-362-6111
  • Fax: 908-362-9638
Mailing address:
  • Phone: 908-362-6111
  • Fax: 908-362-9638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: PAUL BARTKUS
Title or Position: CST DIRECTOR
Credential:
Phone: 908-362-6111