Provider Demographics
NPI:1831361534
Name:BOARD OF EDUCATION BERLIN TOWNSHIP
Entity type:Organization
Organization Name:BOARD OF EDUCATION BERLIN TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BETZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-767-9480
Mailing Address - Street 1:225 GROVE AVENUE
Mailing Address - Street 2:HUSTER ADMINISTRATION BUILDING
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091-1226
Mailing Address - Country:US
Mailing Address - Phone:856-767-9480
Mailing Address - Fax:856-767-9486
Practice Address - Street 1:225 GROVE AVE
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-1226
Practice Address - Country:US
Practice Address - Phone:856-767-9480
Practice Address - Fax:856-767-9486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251300000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0151769Medicaid