Basic Information
| Provider Information | |||||||||
| NPI: | 1245397421 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CINCINNATUS CENTRAL SCHOOL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 500 | ||||||||
| Address2: | |||||||||
| City: | HOMER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130770500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077491226 | ||||||||
| FaxNumber: | 6077492312 | ||||||||
| Practice Location | |||||||||
| Address1: | 2809 CINCINNATUS RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATUS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130409685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6078633200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PASSIGLI | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF SPECIAL EDUCATION | ||||||||
| AuthorizedOfficialTelephone: | 6077491226 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | ED.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | Y | Agencies | Local Education Agency (LEA) |
ID Information
| ID | Type | State | Issuer | Description | 01379400 | 05 | NY | MEDICAID |