Provider Demographics
NPI:1477603520
Name:MALVERNE UFSD
Entity Type:Organization
Organization Name:MALVERNE UFSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-887-6405
Mailing Address - Street 1:301 WICKS LN
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-2244
Mailing Address - Country:US
Mailing Address - Phone:516-887-6405
Mailing Address - Fax:516-255-1007
Practice Address - Street 1:301 WICKS LN
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-2244
Practice Address - Country:US
Practice Address - Phone:516-887-6405
Practice Address - Fax:516-255-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
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
NY01403016Medicaid