=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427214915
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEVERLY EMERGENCY SQUAD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2008
-----------------------------------------------------
Last Update Date | 08/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 703 MELBOURNE AVE
-----------------------------------------------------
City | BEVERLY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-386-7304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 703 MELBOURNE AVE
-----------------------------------------------------
City | BEVERLY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-386-7304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANDREW S BALDINGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-386-7304
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | B0311012
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------