Provider Demographics
NPI:1093718611
Name:ESSEX AMBULANCE ASSOCIATION INCORPORATED
Entity Type:Organization
Organization Name:ESSEX AMBULANCE ASSOCIATION INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-767-1730
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:IVORYTON
Mailing Address - State:CT
Mailing Address - Zip Code:06442-0233
Mailing Address - Country:US
Mailing Address - Phone:860-767-1730
Mailing Address - Fax:860-767-7677
Practice Address - Street 1:149 DENNISON ROAD
Practice Address - Street 2:
Practice Address - City:CENTERBROOK
Practice Address - State:CT
Practice Address - Zip Code:06409
Practice Address - Country:US
Practice Address - Phone:860-767-1730
Practice Address - Fax:860-767-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC050B13416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004010617Medicaid
CT590000091Medicare PIN