Provider Demographics
NPI:1073889754
Name:DEPT OF EDUCATION
Entity Type:Organization
Organization Name:DEPT OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:
Authorized Official - First Name:CELY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSARIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-842-2655
Mailing Address - Street 1:139 KIMBALL TERRENCE
Mailing Address - Street 2:HOUSE
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704
Mailing Address - Country:US
Mailing Address - Phone:718-842-2655
Mailing Address - Fax:718-328-5506
Practice Address - Street 1:1535 STORY AVE
Practice Address - Street 2:SCHOOL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-4555
Practice Address - Country:US
Practice Address - Phone:718-842-2655
Practice Address - Fax:718-328-5506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22-5284873140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric