Provider Demographics
NPI:1679791313
Name:ROSELLE BOARD OF EDUCATION
Entity Type:Organization
Organization Name:ROSELLE BOARD OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-298-2040
Mailing Address - Street 1:710 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-1919
Mailing Address - Country:US
Mailing Address - Phone:908-298-2056
Mailing Address - Fax:908-298-1507
Practice Address - Street 1:710 LOCUST ST
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-1919
Practice Address - Country:US
Practice Address - Phone:908-298-2040
Practice Address - Fax:908-298-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6784305Medicaid