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General NPI Number Information
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NPI Number | 1730558719
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Entity Type | Organization
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Legal Business Name | MOUNTAINSIDE RESCUE SQUAD BOROUGH OF MOUNTAINSIDE, N.J.
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 1399 ROUTE 22
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City | MOUNTAINSIDE
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State | NJ
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Zip | 07092-2401
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Country | US
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Telephone | 908-233-6338
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Fax | 908-233-6573
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Provider Business Mailing Address
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Address Line | 1399 ROUTE 22
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City | MOUNTAINSIDE
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State | NJ
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Zip | 07092-2401
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Country | US
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Telephone | 908-233-6338
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Fax | 908-233-6573
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Authorized Official
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Title or Position | CAPTAIN
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Name | MR. ERIC D PASTORE
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Credential | EMT
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Telephone | 908-233-6338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 2011017
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License Number State | NJ
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