Healthcare Provider Details

I. General information

NPI: 1073750766
Provider Name (Legal Business Name): BREWERTON VOLUNTEER FIRE DEPARTMENT AMBULANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9625 BREWERTON RD
BREWERTON NY
13029-0708
US

IV. Provider business mailing address

PO BOX 535
BALDWINSVILLE NY
13027-0535
US

V. Phone/Fax

Practice location:
  • Phone: 315-668-9789
  • Fax: 315-428-8648
Mailing address:
  • Phone: 315-635-1789
  • Fax: 315-635-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number31865
License Number StateNY

VIII. Authorized Official

Name: AMY TAYLOR
Title or Position: PRESIDENT
Credential:
Phone: 315-676-7724