Healthcare Provider Details

I. General information

NPI: 1134469646
Provider Name (Legal Business Name): MONTAGUE ELEMENTARY SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 ROUTE 206
MONTAGUE NJ
07827-3018
US

IV. Provider business mailing address

475 ROUTE 206
MONTAGUE NJ
07827-3018
US

V. Phone/Fax

Practice location:
  • Phone: 973-293-7131
  • Fax:
Mailing address:
  • Phone: 973-293-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNJ

VIII. Authorized Official

Name: MICHELE HORDYSZYNSKI
Title or Position: SCHOOL SOCIAL WORKER
Credential: MSW
Phone: 973-293-7131