Provider Demographics
NPI:1437290657
Name:JEFFERSON CENTRAL SCHOOL
Entity Type:Organization
Organization Name:JEFFERSON CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-652-7821
Mailing Address - Street 1:1332 STATE ROUTE 10
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12093-3030
Mailing Address - Country:US
Mailing Address - Phone:607-652-7821
Mailing Address - Fax:607-652-7806
Practice Address - Street 1:1332 STATE ROUTE 10
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:12093-3030
Practice Address - Country:US
Practice Address - Phone:607-652-7821
Practice Address - Fax:607-652-7806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01390692Medicaid