Provider Demographics
NPI:1699015123
Name:BERGENFIELD BOARD OF EDUCATION
Entity type:Organization
Organization Name:BERGENFIELD BOARD OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TULLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-385-8801
Mailing Address - Street 1:225 W CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1962
Mailing Address - Country:US
Mailing Address - Phone:291-385-8801
Mailing Address - Fax:201-385-3718
Practice Address - Street 1:225 W CLINTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1962
Practice Address - Country:US
Practice Address - Phone:291-385-8801
Practice Address - Fax:201-385-3718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ7171803251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7171803Medicaid