Provider Demographics
NPI:1891832960
Name:TOWN OF PUTNAM BOARD OF EDUCATION DISTRICT 1
Entity Type:Organization
Organization Name:TOWN OF PUTNAM BOARD OF EDUCATION DISTRICT 1
Other - Org Name:PUTNAM CENTRAL SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-547-8266
Mailing Address - Street 1:PO BOX 91126 COUNTY RT 2
Mailing Address - Street 2:
Mailing Address - City:PUTNAM STATION
Mailing Address - State:NY
Mailing Address - Zip Code:12861-0091
Mailing Address - Country:US
Mailing Address - Phone:518-547-8266
Mailing Address - Fax:518-547-9567
Practice Address - Street 1:126 COUNTY RT 2
Practice Address - Street 2:
Practice Address - City:PUTNAM STATION
Practice Address - State:NY
Practice Address - Zip Code:12861-0091
Practice Address - Country:US
Practice Address - Phone:518-547-8266
Practice Address - Fax:518-547-9567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01506207Medicaid