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General NPI Number Information
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NPI Number | 1578829628
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Entity Type | Organization
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Legal Business Name | WANAMASSA FIRST AID SQUAD
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 1401 WICKAPECKO DRIVE
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City | OCEAN
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State | NJ
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Zip | 07712-4201
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Country | US
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Telephone | 732-915-4304
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Fax | 732-988-3089
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Provider Business Mailing Address
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Address Line | 1401 WICKAPECKO DR
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City | OCEAN
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State | NJ
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Zip | 07712-4201
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Country | US
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Telephone | 732-455-0748
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Fax | 732-988-3089
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Authorized Official
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Title or Position | TRUSTEE
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Name | EARL H GIFFORD
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Credential |
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Telephone | 732-433-0901
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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 | 1311074
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License Number State | NJ
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