Provider Demographics
NPI:1245376185
Name:NORTHEAST CSD
Entity type:Organization
Organization Name:NORTHEAST CSD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASTELLANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-373-4104
Mailing Address - Street 1:194 HAIGHT ROAD
Mailing Address - Street 2:PO BOX 405
Mailing Address - City:AMENIA
Mailing Address - State:NY
Mailing Address - Zip Code:12501-0405
Mailing Address - Country:US
Mailing Address - Phone:845-373-4100
Mailing Address - Fax:845-373-4102
Practice Address - Street 1:194 HAIGHT ROAD
Practice Address - Street 2:
Practice Address - City:AMENIA
Practice Address - State:NY
Practice Address - Zip Code:12501-0405
Practice Address - Country:US
Practice Address - Phone:845-373-4100
Practice Address - Fax:845-373-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01396661Medicaid