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General NPI Number Information
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NPI Number | 1003845736
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Entity Type | Organization
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Legal Business Name | SKENESBOROUGH EMERGENCY SQUAD INC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 05/13/2018
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Provider Practice Location Address
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Address Line | 37 SKENESBOROUGH DR
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City | WHITEHALL
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State | NY
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Zip | 12887
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Country | US
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Telephone | 315-499-2122
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Fax |
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Provider Business Mailing Address
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Address Line | 107 WASHINGTON AVE
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City | ALBANY
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State | NY
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Zip | 12210-2231
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Country | US
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Telephone | 888-603-2455
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Fax | 888-603-2455
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Authorized Official
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Title or Position | CAPTAIN
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Name | MR. BRANDON PAUL SPARKS
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Credential |
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Telephone | 518-499-2122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 10696
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License Number State | NY
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