Provider Demographics
NPI:1972721744
Name:MANSFIELD TOWNSHIP ELEMENTARY SCHOOL
Entity Type:Organization
Organization Name:MANSFIELD TOWNSHIP ELEMENTARY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD STUDY TEAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-689-3212
Mailing Address - Street 1:50 PORT MURRAY RD
Mailing Address - Street 2:
Mailing Address - City:PORT MURRAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07865-4019
Mailing Address - Country:US
Mailing Address - Phone:908-689-3212
Mailing Address - Fax:
Practice Address - Street 1:50 PORT MURRAY RD
Practice Address - Street 2:
Practice Address - City:PORT MURRAY
Practice Address - State:NJ
Practice Address - Zip Code:07865-4019
Practice Address - Country:US
Practice Address - Phone:908-689-3212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
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
NJ6728013Medicaid