1437539780 NPI number — SOUTH TOM'S RIVER VOLUNTEER FIRST AID AND RESCUE SQUAD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437539780 NPI number — SOUTH TOM'S RIVER VOLUNTEER FIRST AID AND RESCUE SQUAD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH TOM'S RIVER VOLUNTEER FIRST AID AND RESCUE SQUAD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437539780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/15/2020
NPI Reactivation Date:
11/24/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 57
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08722-0057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-341-3339
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 DOVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08757-5238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-341-3339
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KROHN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
732-341-3339

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1511040 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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