Provider Demographics
NPI:1740400308
Name:WEST NEW YORK BOARD OF EDUCATION
Entity Type:Organization
Organization Name:WEST NEW YORK BOARD OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZZARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-553-4000
Mailing Address - Street 1:6028 BROADWAY
Mailing Address - Street 2:DEPARTMENT OF SPECIAL SERVICES
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2808
Mailing Address - Country:US
Mailing Address - Phone:201-553-4000
Mailing Address - Fax:201-902-2299
Practice Address - Street 1:6028 BROADWAY
Practice Address - Street 2:DEPARTMENT OF SPECIAL SERVICES
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2808
Practice Address - Country:US
Practice Address - Phone:201-553-4000
Practice Address - Fax:201-902-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6742009Medicaid