Basic Information
| Provider Information | |||||||||
| NPI: | 1669463402 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAIRFIELD TOWNSHIP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FAIRFIELD TWP AMB SRVC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 66 | ||||||||
| Address2: | |||||||||
| City: | BRIDGETON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083200066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004732278 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 43 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564513676 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2005 | ||||||||
| LastUpdateDate: | 04/16/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BATEMAN | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 8564513676 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 | 0X00200379 | 01 | ACS HEALTH NET COMMERCIAL | OTHER | 5113903 | 05 | NJ | MEDICAID | 1079100 | 01 | KEYSTONE MERCY HMO DPA | OTHER | 0X00200379 | 01 | PHS HEALTHPLAN COMMERCIAL | OTHER | 91000397400 | 01 | AMERICHOICE OF NJ INC | OTHER | 91000397400 | 01 | AMERICAN CHOICE | OTHER | 0120129 | 01 | AETNA USHC BLUE BELL HMO | OTHER | 0X00200379 | 01 | ACS HEALTH NET HMO MDC | OTHER | 0X00200379 | 01 | PHS HEALTH PLAN HMO MDC | OTHER | 0X00200379 | 01 | QUALMED | OTHER |