Provider Demographics
NPI:1083831309
Name:IRON BOUND AMBULANCE SQUAD, INC.
Entity Type:Organization
Organization Name:IRON BOUND AMBULANCE SQUAD, INC.
Other - Org Name:IRONBOUND AMBULANCE SQUAD, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVERIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-589-3796
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-0207
Mailing Address - Country:US
Mailing Address - Phone:484-664-2007
Mailing Address - Fax:
Practice Address - Street 1:399 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-3126
Practice Address - Country:US
Practice Address - Phone:973-589-3796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJIRN050063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0093785Medicaid
NJ100065Medicare PIN