Healthcare Provider Details

I. General information

NPI: 1033532478
Provider Name (Legal Business Name): OPPENHEIM-EPHRATAH-ST.JOHNSVILLE CSD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6486 STATE HIGHWAY 29
ST JOHNSVILLE NY
13452-2702
US

IV. Provider business mailing address

6486 STATE HIGHWAY 29
ST JOHNSVILLE NY
13452-2702
US

V. Phone/Fax

Practice location:
  • Phone: 518-568-2014
  • Fax: 518-568-2941
Mailing address:
  • Phone: 518-568-2014
  • Fax: 518-568-2941

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: KAREN METTLER
Title or Position: DISTRICT TREASURER
Credential:
Phone: 518-568-2014