Provider Demographics
NPI:1154478295
Name:BAY SHORE UNION FREE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:BAY SHORE UNION FREE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERK TYPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FAGONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-968-1232
Mailing Address - Street 1:75 W. PERKAL ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6642
Mailing Address - Country:US
Mailing Address - Phone:631-968-1232
Mailing Address - Fax:631-968-1281
Practice Address - Street 1:75 W. PERKAL ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6642
Practice Address - Country:US
Practice Address - Phone:631-968-1232
Practice Address - Fax:631-968-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251300000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========Medicaid