Healthcare Provider Details

I. General information

NPI: 1821074840
Provider Name (Legal Business Name): BALLSTON LAKE EMERGENCY SQUAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 RT 146A
BALLSTON LAKE NY
12019
US

IV. Provider business mailing address

PO BOX 535
BALDWINSVILLE NY
13027-0535
US

V. Phone/Fax

Practice location:
  • Phone: 516-399-7066
  • Fax:
Mailing address:
  • Phone: 315-635-1789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: JOHN BOYD
Title or Position: PRESIDENT
Credential:
Phone: 518-399-7066