Provider Demographics
NPI:1033263587
Name:WANTAGH UFSD
Entity Type:Organization
Organization Name:WANTAGH UFSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST SUPERINTENDENT FOR BUSINESS
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:WISOTZKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-679-6308
Mailing Address - Street 1:3301 BELTAGH AVENUE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793
Mailing Address - Country:US
Mailing Address - Phone:516-679-6308
Mailing Address - Fax:516-785-6302
Practice Address - Street 1:3297 BELTAGH AVENUE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793
Practice Address - Country:US
Practice Address - Phone:516-679-6428
Practice Address - Fax:516-679-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01383311Medicaid