Healthcare Provider Details

I. General information

NPI: 1811976095
Provider Name (Legal Business Name): AVENEL AND COLONIA FIRST AID SQUAD INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 AVENEL ST
AVENEL NJ
07001-1710
US

IV. Provider business mailing address

105 AVENEL ST
AVENEL NJ
07001-1710
US

V. Phone/Fax

Practice location:
  • Phone: 732-636-4640
  • Fax:
Mailing address:
  • Phone: 732-636-4640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. CARMEN PARISIO
Title or Position: CAPTAIN
Credential:
Phone: 732-423-7004