Provider Demographics
NPI:1639291248
Name:PEMBERTON TOWNSHIP SCHOOL DISTRICT
Entity Type:Organization
Organization Name:PEMBERTON TOWNSHIP SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:BUSINESS ADMIN
Authorized Official - Phone:609-893-8141
Mailing Address - Street 1:1 EGBERT ST
Mailing Address - Street 2:
Mailing Address - City:PEMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08068-1211
Mailing Address - Country:US
Mailing Address - Phone:609-893-8141
Mailing Address - Fax:609-894-0586
Practice Address - Street 1:1 EGBERT ST
Practice Address - Street 2:
Practice Address - City:PEMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08068-1211
Practice Address - Country:US
Practice Address - Phone:609-893-8141
Practice Address - Fax:609-894-0586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6544606Medicaid