MEDICARE: EAST HARTFORD BOARD OF EDUCATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)		CT

General Provider Information

NPI Number	:	1275695652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST HARTFORD BOARD OF EDUCATION

Provider Business Mailing Address
First Line	:	1110 MAIN ST
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-2240
Country	:	US
Telephone Number	:	860-622-5122
Fax Number	:	860-622-5124

Provider Business Practice Location Address
First Line	:	1110 MAIN ST
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-2240
Country	:	US
Telephone Number	:	860-622-5122
Fax Number	:	860-622-5124

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MRS. MARION MARTINEZ
Credential	:
Telephone Number	:	860-622-5122

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	08/22/2020

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