Basic Information
| Provider Information | |||||||||
| NPI: | 1245564467 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRANBURY FIRST AID SQUAD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 207 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181050207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846642007 | ||||||||
| FaxNumber: | 4846642015 | ||||||||
| Practice Location | |||||||||
| Address1: | 68 MAPLEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | CRANBURY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085123235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093951707 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2009 | ||||||||
| LastUpdateDate: | 06/07/2010 | ||||||||
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| AuthorizedOfficialLastName: | MOODY | ||||||||
| AuthorizedOfficialFirstName: | DEREK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6095290824 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | C1211011 | NJ | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 0226670 | 05 | NJ | MEDICAID |