Provider Demographics
NPI:1881731651
Name:LAKELAND CENTRAL SCHOOL DISTRICT
Entity type:Organization
Organization Name:LAKELAND CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. SUPERINTENDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-245-1700
Mailing Address - Street 1:1086 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHRUB OAK
Mailing Address - State:NY
Mailing Address - Zip Code:10588-1507
Mailing Address - Country:US
Mailing Address - Phone:914-245-1700
Mailing Address - Fax:914-245-2381
Practice Address - Street 1:1086 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SHRUB OAK
Practice Address - State:NY
Practice Address - Zip Code:10588-1507
Practice Address - Country:US
Practice Address - Phone:914-245-1700
Practice Address - Fax:914-245-2381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01484133Medicaid