Basic Information
| Provider Information | |||||||||
| NPI: | 1558351023 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW PALTZ RESCUE SQUAD, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 207 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181050207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846642007 | ||||||||
| FaxNumber: | 4846642017 | ||||||||
| Practice Location | |||||||||
| Address1: | 74-78 NORTH PUTT CORNERS ROAD | ||||||||
| Address2: | |||||||||
| City: | NEW PALTZ | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125613405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452551719 | ||||||||
| FaxNumber: | 8452553197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 11/07/2012 | ||||||||
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| AuthorizedOfficialLastName: | SOKOTA | ||||||||
| AuthorizedOfficialFirstName: | DEB | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8452551719 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 5526 | NY | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 01364878 | 05 | NY | MEDICAID |