Healthcare Provider Details

I. General information

NPI: 1003150749
Provider Name (Legal Business Name): OGDENSBURG CITY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 KNOX ST
OGDENSBURG NY
13669-2849
US

IV. Provider business mailing address

1100 STATE ST
OGDENSBURG NY
13669-3352
US

V. Phone/Fax

Practice location:
  • Phone: 315-393-7836
  • Fax:
Mailing address:
  • Phone: 315-393-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number515404
License Number StateNY

VIII. Authorized Official

Name: MR. TIMOTHY VERNSEY
Title or Position: SUPERINTENDENT
Credential:
Phone: 315-393-0900