=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427390012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMACK UNION FREE SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2013
-----------------------------------------------------
Last Update Date | 03/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25 MCCULLOCH DR
-----------------------------------------------------
City | DIX HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11746-8303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-858-3573
-----------------------------------------------------
Fax | 631-858-3403
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 MCCULLOCH DR
-----------------------------------------------------
City | DIX HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11746-8303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-858-3573
-----------------------------------------------------
Fax | 631-858-3403
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SCHOOL NURSE
-----------------------------------------------------
Name | GINA HAWKINS
-----------------------------------------------------
Credential | R.N.
-----------------------------------------------------
Telephone | 631-858-3573
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number | 318003
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------