Provider Demographics
NPI:1154470250
Name:NEW YORK STATE DEPARTMENT EDUCATION RUSH HENRIETTA CTRL SCHL DIST 1
Entity Type:Organization
Organization Name:NEW YORK STATE DEPARTMENT EDUCATION RUSH HENRIETTA CTRL SCHL DIST 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:585-359-5012
Mailing Address - Street 1:2034 LEHIGH STATION RD
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9616
Mailing Address - Country:US
Mailing Address - Phone:585-359-5000
Mailing Address - Fax:585-359-5022
Practice Address - Street 1:2034 LEHIGH STATION RD
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9616
Practice Address - Country:US
Practice Address - Phone:585-359-5000
Practice Address - Fax:585-359-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01497492Medicaid