Provider Demographics
NPI:1962777565
Name:DEPT OF EDUCATION,NYC
Entity type:Organization
Organization Name:DEPT OF EDUCATION,NYC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEYAMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-556-3603
Mailing Address - Street 1:195 HAGAMAN PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2035
Mailing Address - Country:US
Mailing Address - Phone:718-556-3603
Mailing Address - Fax:718-720-6851
Practice Address - Street 1:200 WARDWLELL AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:718-556-3603
Practice Address - Fax:718-442-4265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346200-1251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0398275Medicaid