Provider Demographics
NPI:1700936416
Name:DEPOSIT CENTRAL SCHOOL
Entity Type:Organization
Organization Name:DEPOSIT CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHIRKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-467-8506
Mailing Address - Street 1:171 SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:DEPOSIT
Mailing Address - State:NY
Mailing Address - Zip Code:13754-1397
Mailing Address - Country:US
Mailing Address - Phone:607-467-8506
Mailing Address - Fax:607-467-1002
Practice Address - Street 1:171 SECOND STREET
Practice Address - Street 2:
Practice Address - City:DEPOSIT
Practice Address - State:NY
Practice Address - Zip Code:13754-1397
Practice Address - Country:US
Practice Address - Phone:607-464-8506
Practice Address - Fax:607-464-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X
NY251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01397039Medicaid