Provider Demographics
NPI:1497801930
Name:ENLARGED CITY SCHOOL DISTRICT OF TROY, NY
Entity Type:Organization
Organization Name:ENLARGED CITY SCHOOL DISTRICT OF TROY, NY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-328-5003
Mailing Address - Street 1:475 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-5533
Mailing Address - Country:US
Mailing Address - Phone:518-328-5003
Mailing Address - Fax:
Practice Address - Street 1:475 1ST ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-5533
Practice Address - Country:US
Practice Address - Phone:518-328-5003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01378707Medicaid