Provider Demographics
NPI:1689951428
Name:BAY SHORE UFSD
Entity Type:Organization
Organization Name:BAY SHORE UFSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUPIL PERSONNEL SERVICE
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:B
Authorized Official - Last Name:ENDES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-968-1232
Mailing Address - Street 1:75 W PERKAL ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6642
Mailing Address - Country:US
Mailing Address - Phone:631-968-1232
Mailing Address - Fax:
Practice Address - Street 1:75 W PERKAL ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6642
Practice Address - Country:US
Practice Address - Phone:631-968-1232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6769939251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)