Provider Demographics
NPI:1679630768
Name:BAYPORT-BLUE POINT UNION FREE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:BAYPORT-BLUE POINT UNION FREE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUPIL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KRIVOSHEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:631-472-8510
Mailing Address - Street 1:189 ACADEMY ST
Mailing Address - Street 2:ADMINISTRATIVE CENTER
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1704
Mailing Address - Country:US
Mailing Address - Phone:631-472-8510
Mailing Address - Fax:631-472-7867
Practice Address - Street 1:189 ACADEMY ST
Practice Address - Street 2:ADMINISTRATIVE CENTER
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1704
Practice Address - Country:US
Practice Address - Phone:631-472-8510
Practice Address - Fax:631-472-7867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01379042Medicaid