Healthcare Provider Details

I. General information

NPI: 1609859883
Provider Name (Legal Business Name): CHATHAM RESCUE SQUAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MOORE AVE
CHATHAM NY
12037-1424
US

IV. Provider business mailing address

PO BOX 535
BALDWINSVILLE NY
13027-0535
US

V. Phone/Fax

Practice location:
  • Phone: 518-392-9080
  • Fax: 518-392-0888
Mailing address:
  • Phone: 315-635-1789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number09686
License Number StateNY

VIII. Authorized Official

Name: ADAM WEISS
Title or Position: CHIEF OF OPERATIONS
Credential:
Phone: 518-938-1108