Provider Demographics
NPI:1962744680
Name:COMMACK UFSD
Entity type:Organization
Organization Name:COMMACK UFSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE/ SCHOOL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:R N
Authorized Official - Phone:631-858-3595
Mailing Address - Street 1:151 KINGS PARK RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1643
Mailing Address - Country:US
Mailing Address - Phone:631-858-3595
Mailing Address - Fax:631-858-3618
Practice Address - Street 1:151 KINGS PARK RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1643
Practice Address - Country:US
Practice Address - Phone:631-858-3595
Practice Address - Fax:631-858-3618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY409238251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY251300000XMedicaid