=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235113804
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHNSBURG EMERGENCY SQUAD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2005
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 624 PEACEFUL VALLEY ROAD
-----------------------------------------------------
City | NORTH CREEK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-251-2244
-----------------------------------------------------
Fax | 518-251-2257
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 624 PEACEFUL VALLEY ROAD
-----------------------------------------------------
City | NORTH CREEK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-251-2244
-----------------------------------------------------
Fax | 518-251-2257
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JOSEPH CHARLES CONNELLY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 518-812-5282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 09840
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------