Basic Information
| Provider Information | |||||||||
| NPI: | 1982603544 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RAHWAY FIRST AID EMERGENCY SQUAD | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | RAHWAY EMERGENCY SQUAD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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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: | 905 STONE ST | ||||||||
| Address2: | |||||||||
| City: | RAHWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070652742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328150464 | ||||||||
| FaxNumber: | 7329562101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2005 | ||||||||
| LastUpdateDate: | 04/26/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JANUIK | ||||||||
| AuthorizedOfficialFirstName: | TORY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 7328150464 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 112577 | 01 | NJ | AMERIGROUP | OTHER | 1167513 | 01 | NJ | HORIZON HEALTHCARE | OTHER | 90020360001 | 01 | NJ | CIGNA | OTHER | A2724245 | 01 | NJ | OXFORD | OTHER | 8989702 | 05 | NJ | MEDICAID | 3017724 | 01 | NJ | AETNA | OTHER | 910007918 00 | 01 | NJ | AMERICHOICE | OTHER | 0X00J25601 | 01 | NJ | HEALTHNET | OTHER |