Provider Demographics
NPI:1609116136
Name:WEST DEPTFORD BOE
Entity Type:Organization
Organization Name:WEST DEPTFORD BOE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST SUPERINTENDENT FOR BUSINESS
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-848-4300
Mailing Address - Street 1:675 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08066-1925
Mailing Address - Country:US
Mailing Address - Phone:856-848-4300
Mailing Address - Fax:856-845-5743
Practice Address - Street 1:675 GROVE RD
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08066-1925
Practice Address - Country:US
Practice Address - Phone:856-848-4300
Practice Address - Fax:856-845-5743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========Medicaid