Provider Demographics
NPI:1477957462
Name:PATERSON CHARTER SCHOOL FOR SCIENCE AND TECHNOLOGY
Entity Type:Organization
Organization Name:PATERSON CHARTER SCHOOL FOR SCIENCE AND TECHNOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SBA/BOARD SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:IRFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVCIL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:973-873-0003
Mailing Address - Street 1:669 RIVER DR
Mailing Address - Street 2:STE 140
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1312
Mailing Address - Country:US
Mailing Address - Phone:973-873-0003
Mailing Address - Fax:973-247-1082
Practice Address - Street 1:196 W RAILWAY AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2227
Practice Address - Country:US
Practice Address - Phone:973-247-0600
Practice Address - Fax:973-247-9924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ807503970251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0159697Medicaid