Provider Demographics
NPI:1699816512
Name:EAST WILLISTON UFSD
Entity Type:Organization
Organization Name:EAST WILLISTON UFSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. OF SPECIAL EDUCATION
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-333-5690
Mailing Address - Street 1:11 BACON RD
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1502
Mailing Address - Country:US
Mailing Address - Phone:516-333-5690
Mailing Address - Fax:
Practice Address - Street 1:11 BACON RD
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1502
Practice Address - Country:US
Practice Address - Phone:516-333-5690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01381800Medicaid