Provider Demographics
NPI:1467508564
Name:BELLMORE MERRICK CHSD
Entity Type:Organization
Organization Name:BELLMORE MERRICK CHSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:KIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-992-1001
Mailing Address - Street 1:1260 MEADOWBROOK ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566
Mailing Address - Country:US
Mailing Address - Phone:516-992-1050
Mailing Address - Fax:516-705-0821
Practice Address - Street 1:1260 MEADOWBROOK ROAD
Practice Address - Street 2:
Practice Address - City:NORTH MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566
Practice Address - Country:US
Practice Address - Phone:516-992-1050
Practice Address - Fax:516-705-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01500792Medicaid