Healthcare Provider Details

I. General information

NPI: 1427048990
Provider Name (Legal Business Name): MADRID RESCUE SQUAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DEPOT ST
MADRID NY
13660-3104
US

IV. Provider business mailing address

PO BOX 290184
WETHERSFIELD CT
06129-0184
US

V. Phone/Fax

Practice location:
  • Phone: 315-322-4011
  • Fax: 315-322-4085
Mailing address:
  • Phone: 860-257-9201
  • Fax: 860-721-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number4420
License Number StateNY

VIII. Authorized Official

Name: MS. MARY T GENTILE
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 860-257-9201