Provider Demographics
NPI:1639215262
Name:WESTBURY UFSD
Entity type:Organization
Organization Name:WESTBURY UFSD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SP. ED.
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO JR.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-874-1878
Mailing Address - Street 1:6 HITCHCOCK LN
Mailing Address - Street 2:2 HITCHCOCK LANE
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1615
Mailing Address - Country:US
Mailing Address - Phone:516-876-5119
Mailing Address - Fax:516-876-5118
Practice Address - Street 1:6 HITCHCOCK LN
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1615
Practice Address - Country:US
Practice Address - Phone:516-876-5119
Practice Address - Fax:516-876-5118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01383462Medicaid