Provider Demographics
NPI:1740406545
Name:PHILLIPSBURG SCHOOL DISTRICT
Entity Type:Organization
Organization Name:PHILLIPSBURG SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:GORDAN
Authorized Official - Last Name:PETHICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-213-2501
Mailing Address - Street 1:445 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2658
Mailing Address - Country:US
Mailing Address - Phone:908-454-3400
Mailing Address - Fax:908-213-2143
Practice Address - Street 1:445 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2658
Practice Address - Country:US
Practice Address - Phone:908-454-3400
Practice Address - Fax:908-213-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
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
NJ728201Medicaid