Provider Demographics
NPI:1407908973
Name:MILLER PLACE UFSD
Entity Type:Organization
Organization Name:MILLER PLACE UFSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL BUSINESS OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:CARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-474-2700
Mailing Address - Street 1:7 MEMORIAL DR
Mailing Address - Street 2:MILLER PLACE UNION FREE SCHOOL DISTRICT
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764
Mailing Address - Country:US
Mailing Address - Phone:631-474-2700
Mailing Address - Fax:631-331-8832
Practice Address - Street 1:275 ROUTE 25A UNIT 43
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2407
Practice Address - Country:US
Practice Address - Phone:631-474-2700
Practice Address - Fax:631-331-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01220864Medicaid