Healthcare Provider Details

I. General information

NPI: 1891119632
Provider Name (Legal Business Name): HAMPTON LAKES EMERGENCY SQUAD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HOLLY BLVD
SOUTHAMPTON NJ
08088
US

IV. Provider business mailing address

PO BOX 18533
PITTSBURGH PA
15236-0533
US

V. Phone/Fax

Practice location:
  • Phone: 609-859-1482
  • Fax: 609-859-2853
Mailing address:
  • Phone: 800-240-6365
  • Fax: 724-234-4703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number100630
License Number StateNJ

VIII. Authorized Official

Name: MR. RICHARD J. SHAW
Title or Position: PRESIDENT
Credential:
Phone: 888-240-1780