1992845085 NPI number — BERKSHIRE EMERGENCY SQUAD INC

Table of content: (NPI 1992845085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992845085 NPI number — BERKSHIRE EMERGENCY SQUAD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERKSHIRE EMERGENCY 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:
6
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:
1992845085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8020 E MAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LE ROY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14482-9704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-716-8015
Provider Business Mailing Address Fax Number:
585-768-7323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 PARK STREET
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
NEWARK VALLEY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13811-0506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-642-3451
Provider Business Practice Location Address Fax Number:
607-642-5036
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GALLUZZO
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
607-642-3451

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0680 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02368069 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com