MEDICARE: CALDWELL-WEST CALDWELL

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)		NJ

General Provider Information

NPI Number	:	1376948695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALDWELL-WEST CALDWELL

Provider Business Mailing Address
First Line	:	104 GRAY ST
Second Line	:	HARRISON SCHOOL
City	:	WEST CALDWELL
State	:	NJ
Zip	:	07006-7615
Country	:	US
Telephone Number	:	973-228-5291
Fax Number	:	973-830-2310

Provider Business Practice Location Address
First Line	:	104 GRAY ST
Second Line	:	HARRISON SCHOOL
City	:	WEST CALDWELL
State	:	NJ
Zip	:	07006-7615
Country	:	US
Telephone Number	:	973-228-5291
Fax Number	:	973-830-2310

Authorized Official
Title or Position	:	DIRECTOR OF SPECIAL SERVICES
Name	:	MR. PAUL PALOZZOLA
Credential	:
Telephone Number	:	973-228-5291

Provider Enumeration Date	:	10/29/2014
Last Update Date	:	11/03/2014

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