Provider Demographics
NPI:1477610624
Name:PORT BYRON CENTRAL SCHOOL DISTRICT
Entity type:Organization
Organization Name:PORT BYRON CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL PROGRAMS
Authorized Official - Prefix:MS
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:LUDWIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-776-5569
Mailing Address - Street 1:30 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT BYRON
Mailing Address - State:NY
Mailing Address - Zip Code:13140-3404
Mailing Address - Country:US
Mailing Address - Phone:315-776-5569
Mailing Address - Fax:315-776-9824
Practice Address - Street 1:30 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:PORT BYRON
Practice Address - State:NY
Practice Address - Zip Code:13140-3404
Practice Address - Country:US
Practice Address - Phone:315-776-5569
Practice Address - Fax:315-776-9824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
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
NY01378550Medicaid