Provider Demographics
NPI:1124245741
Name:BERGEN COUNTY SPECIAL SERVICES SCHOOL DISTRICT
Entity type:Organization
Organization Name:BERGEN COUNTY SPECIAL SERVICES SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUP OF INSTRUCTION
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-343-6000
Mailing Address - Street 1:327 EAST RIDGEWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2915
Mailing Address - Country:US
Mailing Address - Phone:201-343-6000
Mailing Address - Fax:201-996-6974
Practice Address - Street 1:327 EAST RIDGEWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2915
Practice Address - Country:US
Practice Address - Phone:201-343-6000
Practice Address - Fax:201-996-6974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7623208Medicaid