Basic Information
| Provider Information | |||||||||
| NPI: | 1528212537 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BOROUGH OF FORT LEE | ||||||||
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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: | 309 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FORT LEE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070244705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013472114 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2008 | ||||||||
| LastUpdateDate: | 07/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | FLAVIA | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | EMS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2015923637 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 0223859 | 05 | NJ | MEDICAID |