Provider Demographics
NPI:1104862887
Name:NORTH SHORE VOLUNTEER EMERGENCY SQUAD INC
Entity Type:Organization
Organization Name:NORTH SHORE VOLUNTEER EMERGENCY SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-635-1789
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:315-635-1789
Mailing Address - Fax:315-635-3289
Practice Address - Street 1:136 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:NY
Practice Address - Zip Code:13042
Practice Address - Country:US
Practice Address - Phone:315-675-3110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10621341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01828757Medicaid
318534OtherMVP
590012354OtherPALMETTO GBA
NYBB0596Medicare ID - Type Unspecified