MEDICARE: HADLEY LUZERNE CENTRAL SCHOOL DISTRICT

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)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760536072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HADLEY LUZERNE CENTRAL SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	27 BEN ROSA PARK
Second Line	:
City	:	LAKE LUZERNE
State	:	NY
Zip	:	12845-0200
Country	:	US
Telephone Number	:	518-696-2112
Fax Number	:	518-696-5402

Provider Business Practice Location Address
First Line	:	27 BEN ROSA PARK
Second Line	:
City	:	LAKE LUZERNE
State	:	NY
Zip	:	12845-0200
Country	:	US
Telephone Number	:	518-696-2112
Fax Number	:	518-696-5402

Authorized Official
Title or Position	:	BUSINESS ADMINISTRATOR
Name	:	MR. VICTOR M DEBONIS
Credential	:
Telephone Number	:	518-696-2112

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	08/22/2020

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Directions to “HADLEY LUZERNE CENTRAL SCHOOL DISTRICT ” Practice Location

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