Provider Demographics
NPI:1336216282
Name:WETHERSFIELD PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:WETHERSFIELD PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-571-8117
Mailing Address - Street 1:127 HARTFORD AVENUE
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1809
Mailing Address - Country:US
Mailing Address - Phone:860-571-8117
Mailing Address - Fax:860-571-8136
Practice Address - Street 1:127 HARTFORD AVENUE
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1809
Practice Address - Country:US
Practice Address - Phone:860-571-8117
Practice Address - Fax:860-571-8136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004053930Medicaid
CT004096740Medicaid