Healthcare Provider Details

I. General information

NPI: 1275662462
Provider Name (Legal Business Name): LODI VOLUNTEER AMBULANCE RESCUE SQUAD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 KIMMIG AVENUE
LODI NJ
07644-1418
US

IV. Provider business mailing address

P.O. BOX 299
LODI NJ
07644
US

V. Phone/Fax

Practice location:
  • Phone: 973-546-3488
  • Fax:
Mailing address:
  • Phone: 973-546-1069
  • Fax: 973-478-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberL0211036
License Number StateNJ

VIII. Authorized Official

Name: MR. JOSEPH TAORMINA
Title or Position: TREASURER
Credential:
Phone: 973-546-1069