Provider Demographics
NPI:1184771602
Name:DRYDEN CSD
Entity type:Organization
Organization Name:DRYDEN CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNRIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-844-5361
Mailing Address - Street 1:118 FREEVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13053-0088
Mailing Address - Country:US
Mailing Address - Phone:607-844-5361
Mailing Address - Fax:607-844-4733
Practice Address - Street 1:118 FREEVILLE ROAD
Practice Address - Street 2:
Practice Address - City:DRYDEN
Practice Address - State:NY
Practice Address - Zip Code:13053
Practice Address - Country:US
Practice Address - Phone:607-844-5361
Practice Address - Fax:607-844-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
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
NY01390454Medicaid