Healthcare Provider Details

I. General information

NPI: 1750379293
Provider Name (Legal Business Name): ROY B PETTENGILL AMB ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 HEBRON RD
MARLBOROUGH CT
06447-1202
US

IV. Provider business mailing address

PO BOX 165
BRANFORD CT
06405-0165
US

V. Phone/Fax

Practice location:
  • Phone: 860-295-6219
  • Fax: 860-295-0604
Mailing address:
  • Phone: 860-663-3634
  • Fax: 860-452-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberC079B1
License Number StateCT

VIII. Authorized Official

Name: LORI A TARKA
Title or Position: PRESIDENT
Credential:
Phone: 860-402-5899