Provider Demographics
NPI:1366596108
Name:VESTAL CENTRAL SCHOOL DISTRICT
Entity type:Organization
Organization Name:VESTAL CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUPIL PERSONNEL SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:ETINGOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-757-2289
Mailing Address - Street 1:201 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1520
Mailing Address - Country:US
Mailing Address - Phone:607-757-2289
Mailing Address - Fax:607-757-2227
Practice Address - Street 1:201 MAIN ST
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1520
Practice Address - Country:US
Practice Address - Phone:607-757-2289
Practice Address - Fax:607-757-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01383137Medicaid