Provider Demographics
NPI:1508398157
Name:MAGNOLIA PUBLIC SCHOOL
Entity Type:Organization
Organization Name:MAGNOLIA PUBLIC SCHOOL
Other - Org Name:MAGNOLIA ELEMENTARY SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS ADMINISTATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:GONOTOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-962-8822
Mailing Address - Street 1:420 N WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:NJ
Mailing Address - Zip Code:08049-1320
Mailing Address - Country:US
Mailing Address - Phone:856-783-6343
Mailing Address - Fax:856-741-1407
Practice Address - Street 1:420 N WARWICK RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:NJ
Practice Address - Zip Code:08049-1320
Practice Address - Country:US
Practice Address - Phone:856-783-6343
Practice Address - Fax:856-741-1407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ000251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)