1710977285 NPI number — NORTH GREENBUSH AMBULANCE ASSOCIATION INC

Table of content: (NPI 1710977285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710977285 NPI number — NORTH GREENBUSH AMBULANCE ASSOCIATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH GREENBUSH AMBULANCE ASSOCIATION 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:
1710977285
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5530 SHERIDAN DR
Provider Second Line Business Mailing Address:
SUITE 3B
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-3730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-204-3350
Provider Business Mailing Address Fax Number:
716-634-7670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 MAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYNANTSKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12198-8219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-283-5511
Provider Business Practice Location Address Fax Number:
518-283-7781
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
518-283-5511

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02201123 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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