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General NPI Number Information
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NPI Number | 1730564436
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Entity Type | Organization
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Legal Business Name | JACKSON TOWNSHIP FIRST AID SQUAD INC
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Dates
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Enumeration Date | 07/23/2015
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Last Update Date | 03/11/2016
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Provider Practice Location Address
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Address Line | 38 E VETERANS HWY
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City | JACKSON
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State | NJ
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Zip | 08527-4519
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Country | US
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Telephone | 732-928-0278
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Fax | 732-928-3460
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Provider Business Mailing Address
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Address Line | PO BOX 516
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City | JACKSON
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State | NJ
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Zip | 08527-0516
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Country | US
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Telephone | 732-928-0278
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Fax | 732-928-3460
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Authorized Official
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Title or Position | CHIEF
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Name | ALFRED COUCEIRO
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Credential |
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Telephone | 732-928-0278
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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 | 1511019
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License Number State | NJ
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