Provider Demographics
NPI:1992842686
Name:NORTHPORT-EAST NORTHPORT UFSD
Entity Type:Organization
Organization Name:NORTHPORT-EAST NORTHPORT UFSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF PUPIL SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-262-6616
Mailing Address - Street 1:PO BOX 210
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-0210
Mailing Address - Country:US
Mailing Address - Phone:631-262-6616
Mailing Address - Fax:631-262-6621
Practice Address - Street 1:158 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3167
Practice Address - Country:US
Practice Address - Phone:631-262-6616
Practice Address - Fax:631-262-6621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
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
NY01378541Medicaid