Provider Demographics
NPI:1932239571
Name:CITY OF MALDEN
Entity Type:Organization
Organization Name:CITY OF MALDEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:MR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:D ED
Authorized Official - Phone:781-397-7204
Mailing Address - Street 1:200 PLEASANT ST
Mailing Address - Street 2:ROOM 109
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4802
Mailing Address - Country:US
Mailing Address - Phone:781-397-7204
Mailing Address - Fax:781-397-7276
Practice Address - Street 1:200 PLEASANT ST
Practice Address - Street 2:ROOM 109
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-4802
Practice Address - Country:US
Practice Address - Phone:781-397-7204
Practice Address - Fax:781-397-7276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1951572Medicaid