Provider Demographics
NPI:1821141367
Name:PATCHOGUE-MEDFORD UFSD
Entity Type:Organization
Organization Name:PATCHOGUE-MEDFORD UFSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SUPERINTENDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARJORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-687-6440
Mailing Address - Street 1:121 SAXTON ST
Mailing Address - Street 2:OFFICE OF PUPIL SERVICES
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1817
Mailing Address - Country:US
Mailing Address - Phone:631-687-6440
Mailing Address - Fax:631-687-6459
Practice Address - Street 1:121 SAXTON ST
Practice Address - Street 2:OFFICE OF PUPIL SERVICES
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1817
Practice Address - Country:US
Practice Address - Phone:631-687-6440
Practice Address - Fax:631-687-6459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
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
NY01377233Medicaid