Provider Demographics
NPI:1568516763
Name:COXSACKIE-ATHENS CSD
Entity Type:Organization
Organization Name:COXSACKIE-ATHENS CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:COPLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-731-1715
Mailing Address - Street 1:24 SUNSET BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:COXSACKIE
Mailing Address - State:NY
Mailing Address - Zip Code:12051-1199
Mailing Address - Country:US
Mailing Address - Phone:518-731-1715
Mailing Address - Fax:518-731-1729
Practice Address - Street 1:24 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:COXSACKIE
Practice Address - State:NY
Practice Address - Zip Code:12051-1132
Practice Address - Country:US
Practice Address - Phone:518-731-1715
Practice Address - Fax:518-731-1729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01558323Medicaid