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General NPI Number Information
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NPI Number | 1093718611
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Entity Type | Organization
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Legal Business Name | ESSEX AMBULANCE ASSOCIATION INCORPORATED
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 149 DENNISON ROAD
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City | CENTERBROOK
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State | CT
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Zip | 06409
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Country | US
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Telephone | 860-767-1730
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Fax | 860-767-7677
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Provider Business Mailing Address
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Address Line | PO BOX 233
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City | IVORYTON
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State | CT
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Zip | 06442-0233
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Country | US
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Telephone | 860-767-1730
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Fax | 860-767-7677
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Authorized Official
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Title or Position | TREASURER
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Name | MS. JUDITH A REYNOLDS
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Credential |
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Telephone | 860-767-1730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | C050B1
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License Number State | CT
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