=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437023413
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWN OF BERLIN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2025
-----------------------------------------------------
Last Update Date | 10/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17563 NY STATE ROUTE 22
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-658-2161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 307
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12022-0307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-573-4261
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TOWN SUPERVISOR
-----------------------------------------------------
Name | MR. ROBERT CHARLES JAEGER
-----------------------------------------------------
Credential | ELECTED OFFICIAL
-----------------------------------------------------
Telephone | 518-573-4261
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------