Provider Demographics
NPI:1558412213
Name:SOUTHOLD UFSD
Entity Type:Organization
Organization Name:SOUTHOLD UFSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-765-5400
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-0470
Mailing Address - Country:US
Mailing Address - Phone:631-765-5400
Mailing Address - Fax:631-765-5086
Practice Address - Street 1:420 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-1700
Practice Address - Country:US
Practice Address - Phone:631-765-5400
Practice Address - Fax:631-765-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
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
NY01416393Medicaid