MEDICARE: PASSAIC VALLEY HIGH SCHOOL

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)

General Provider Information

NPI Number	:	1548432883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASSAIC VALLEY HIGH SCHOOL

Provider Business Mailing Address
First Line	:	100 E MAIN ST
Second Line	:
City	:	LITTLE FALLS
State	:	NJ
Zip	:	07424-5628
Country	:	US
Telephone Number	:	973-890-2500
Fax Number	:	973-890-0512

Provider Business Practice Location Address
First Line	:	100 E MAIN ST
Second Line	:
City	:	LITTLE FALLS
State	:	NJ
Zip	:	07424-5628
Country	:	US
Telephone Number	:	973-890-2500
Fax Number	:	973-890-0512

Authorized Official
Title or Position	:	BUSINESS ADMINISTRATOR
Name	:	MR. PAUL GERBER
Credential	:
Telephone Number	:	973-890-2500

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	03/27/2008

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