Provider Demographics
NPI:1376697672
Name:MIDDLE COUNTRY CSD
Entity Type:Organization
Organization Name:MIDDLE COUNTRY CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR OF SPECIAL EDUCAION
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:VERBEECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-285-8861
Mailing Address - Street 1:25 N BICYCLE PATH STE A
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 N BICYCLE PATH STE A
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2241
Practice Address - Country:US
Practice Address - Phone:631-285-8861
Practice Address - Fax:631-285-8851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01379946Medicaid