Provider Demographics
NPI:1023201134
Name:PASSAIC COUNTY TECHNICAL INSTITUTE
Entity Type:Organization
Organization Name:PASSAIC COUNTY TECHNICAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-389-4197
Mailing Address - Street 1:45 REINHARDT RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2210
Mailing Address - Country:US
Mailing Address - Phone:973-389-4197
Mailing Address - Fax:973-389-2030
Practice Address - Street 1:45 REINHARDT RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2210
Practice Address - Country:US
Practice Address - Phone:973-389-4197
Practice Address - Fax:973-389-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6396704Medicaid