=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093253742
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADIRONDACK STRETCHER AND AMBULETTE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2017
-----------------------------------------------------
Last Update Date | 02/02/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 STATE HIGHWAY 29A
-----------------------------------------------------
City | GLOVERSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12078-6740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-848-5884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 520 STATE HIGHWAY 29A
-----------------------------------------------------
City | GLOVERSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12078-6740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-848-5884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RICHARD SCOTT MOSETTI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 518-848-5884
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------