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General NPI Number Information
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NPI Number | 1750379293
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Entity Type | Organization
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Legal Business Name | ROY B PETTENGILL AMB ASSOC
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 7 HEBRON RD
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City | MARLBOROUGH
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State | CT
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Zip | 06447-1202
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Country | US
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Telephone | 860-295-6219
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Fax | 860-295-0604
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Provider Business Mailing Address
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Address Line | PO BOX 165
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City | BRANFORD
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State | CT
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Zip | 06405-0165
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Country | US
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Telephone | 860-663-3634
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Fax | 860-452-4430
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Authorized Official
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Title or Position | PRESIDENT
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Name | LORI A TARKA
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Credential |
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Telephone | 860-402-5899
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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 | C079B1
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License Number State | CT
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