MEDICARE: NORTHEAST QUADRANT ADVANCED LIFE SUPPORT INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	2783	NY
2	341600000X	Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PNEQUADNALS	OTHER	NY	MONROE PLAN

General Provider Information

NPI Number	:	1508833385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST QUADRANT ADVANCED LIFE SUPPORT INC

Provider Business Mailing Address
First Line	:	PO BOX 16996
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14616-0996
Country	:	US
Telephone Number	:	888-376-1075
Fax Number	:	585-434-3312

Provider Business Practice Location Address
First Line	:	1030 JACKSON RD
Second Line	:
City	:	WEBSTER
State	:	NY
Zip	:	14580-8705
Country	:	US
Telephone Number	:	585-563-1112
Fax Number	:	585-434-3312

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CIHAT TEKIN
Credential	:
Telephone Number	:	888-376-1075

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	02/08/2023

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