Healthcare Provider Details

I. General information

NPI: 1700801222
Provider Name (Legal Business Name): NORTHEAST REGIONAL AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 AJOOTIAN WAY UNIT D-2
MIDDLETON MA
01949-2490
US

IV. Provider business mailing address

3 AJOOTIAN WAY UNIT D-2
MIDDLETON MA
01949-2490
US

V. Phone/Fax

Practice location:
  • Phone: 978-777-5813
  • Fax: 978-777-5902
Mailing address:
  • Phone: 978-777-5813
  • Fax: 978-777-5902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number3988
License Number StateMA

VIII. Authorized Official

Name: MR. BRIAN P. CAPONIGRO
Title or Position: PRESIDENT
Credential:
Phone: 978-777-5813