Healthcare Provider Details

I. General information

NPI: 1609073352
Provider Name (Legal Business Name): BROADALBIN VOLUNTEER AMBULANCE CORP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CENTER STREET
BROADALBIN NY
12025
US

IV. Provider business mailing address

PO BOX 4066
UTICA NY
13504-4066
US

V. Phone/Fax

Practice location:
  • Phone: 518-705-3005
  • Fax:
Mailing address:
  • Phone: 315-724-6619
  • Fax: 315-797-2589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1716
License Number StateNY

VIII. Authorized Official

Name: MS. LISA PFEIFFER
Title or Position: PRESIDENT
Credential:
Phone: 518-705-3005