Provider Demographics
NPI:1619026861
Name:HERRICKS UFSD
Entity Type:Organization
Organization Name:HERRICKS UFSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BIERWIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-305-8901
Mailing Address - Street 1:999 HERRICKS RD STE B
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1353
Mailing Address - Country:US
Mailing Address - Phone:516-305-8901
Mailing Address - Fax:516-248-3131
Practice Address - Street 1:999 HERRICKS RD STE B
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1353
Practice Address - Country:US
Practice Address - Phone:516-305-8901
Practice Address - Fax:516-248-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01429152Medicaid