Provider Demographics
NPI:1104042159
Name:PASSAIC BOARD OF EDUCATION
Entity Type:Organization
Organization Name:PASSAIC BOARD OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-470-5240
Mailing Address - Street 1:101 PASSAIC AVE
Mailing Address - Street 2:P.O. BOX 388
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4828
Mailing Address - Country:US
Mailing Address - Phone:973-470-5240
Mailing Address - Fax:973-470-7694
Practice Address - Street 1:101 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4828
Practice Address - Country:US
Practice Address - Phone:973-470-5240
Practice Address - Fax:973-470-7694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6470009Medicaid