Healthcare Provider Details

I. General information

NPI: 1003147794
Provider Name (Legal Business Name): HOPATCONG AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 RIVER STYX RD
HOPATCONG NJ
07843-1827
US

IV. Provider business mailing address

PO BOX 1016
VOORHEES NJ
08043-7016
US

V. Phone/Fax

Practice location:
  • Phone: 973-770-0440
  • Fax: 973-810-5589
Mailing address:
  • Phone: 856-784-3715
  • Fax: 856-768-2739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberH1911010
License Number StateNJ

VIII. Authorized Official

Name: RITA RUSSOMANNO
Title or Position: PRESIDENT
Credential:
Phone: 973-770-0440