Healthcare Provider Details

I. General information

NPI: 1912098674
Provider Name (Legal Business Name): NORTHEAST FIRST AID CORPS.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 RHAWN ST
PHILADELPHIA PA
19136-2732
US

IV. Provider business mailing address

4411 RHAWN ST
PHILADELPHIA PA
19136-2732
US

V. Phone/Fax

Practice location:
  • Phone: 215-624-9111
  • Fax: 215-331-7711
Mailing address:
  • Phone: 215-624-9111
  • Fax: 215-331-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number05126
License Number StatePA

VIII. Authorized Official

Name: MR. ROBERT P BERKOFF
Title or Position: ADMINISTRATOR
Credential:
Phone: 215-624-9111