Provider Demographics
NPI:1346307360
Name:TOWN OF TICONDEROGA BOARD OF EDUCATION
Entity Type:Organization
Organization Name:TOWN OF TICONDEROGA BOARD OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:518-585-7437
Mailing Address - Street 1:9 AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-1430
Mailing Address - Country:US
Mailing Address - Phone:518-585-7437
Mailing Address - Fax:518-585-2682
Practice Address - Street 1:9 AMHERST AVE
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-1430
Practice Address - Country:US
Practice Address - Phone:518-585-7437
Practice Address - Fax:518-585-2682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01418395Medicaid