Provider Demographics
NPI:1609900281
Name:PORTVILLE CENTRAL SCHOOL DISTRICT
Entity Type:Organization
Organization Name:PORTVILLE CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-933-6000
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:500 ELM STREET
Mailing Address - City:PORTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14770
Mailing Address - Country:US
Mailing Address - Phone:716-933-6000
Mailing Address - Fax:716-933-7124
Practice Address - Street 1:500 ELM STREET
Practice Address - Street 2:
Practice Address - City:PORTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14770
Practice Address - Country:US
Practice Address - Phone:716-933-6000
Practice Address - Fax:716-933-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01377119Medicaid