=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407903123
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROOSEVELT UNION FREE SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2007
-----------------------------------------------------
Last Update Date | 04/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 240 DENTON PL
-----------------------------------------------------
City | ROOSEVELT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11575-1539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-345-7850
-----------------------------------------------------
Fax | 516-345-7799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 240 DENTON PL
-----------------------------------------------------
City | ROOSEVELT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11575-1539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-345-7850
-----------------------------------------------------
Fax | 516-345-7799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PUPIL PERSONNEL SERVICE
-----------------------------------------------------
Name | DR. DIONNE WYNN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-345-7850
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------