Healthcare Provider Details

I. General information

NPI: 1336487461
Provider Name (Legal Business Name): MEDFORCE AMBULANCE MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E BARBOUR ST 1ST FLOOR
HALEDON NJ
07508-1546
US

IV. Provider business mailing address

60 E BARBOUR ST 1ST FLOOR
HALEDON NJ
07508-1546
US

V. Phone/Fax

Practice location:
  • Phone: 201-275-7310
  • Fax:
Mailing address:
  • Phone: 201-275-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number100569
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number100569
License Number StateNJ

VIII. Authorized Official

Name: WILLIAM DIAZ
Title or Position: PRESIDENT
Credential: EMT
Phone: 201-275-7310