Healthcare Provider Details

I. General information

NPI: 1588714257
Provider Name (Legal Business Name): EAST MORICHES UNION FREE SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 ADELAIDE AVE
EAST MORICHES NY
11940-1370
US

IV. Provider business mailing address

9 ADELAIDE AVE
EAST MORICHES NY
11940-1370
US

V. Phone/Fax

Practice location:
  • Phone: 631-878-0162
  • Fax: 631-878-0186
Mailing address:
  • Phone: 631-878-0162
  • Fax: 631-878-0186

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: DR. CHARLES T RUSSO
Title or Position: SUPERINTENDENT
Credential:
Phone: 631-878-0162