=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366879744
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLD SPRING HARBOR CENTRAL SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2013
-----------------------------------------------------
Last Update Date | 10/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 SCHOOL LN
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11743-1039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-367-5900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 SCHOOL LN
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11743-1039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF SPECIAL ED PPS
-----------------------------------------------------
Name | DENISE CAMPBELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 631-637-5900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1000X
-----------------------------------------------------
Taxonomy Name | Student Health Clinic/Center
-----------------------------------------------------
License Number | 4369401
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------