Provider Demographics
NPI:1154836450
Name:TOWN OF NORTH HAVEN
Entity Type:Organization
Organization Name:TOWN OF NORTH HAVEN
Other - Org Name:NORTH HAVEN FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:JANUSZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-239-5321
Mailing Address - Street 1:18 CHURCH STREET
Mailing Address - Street 2:FIRE DEPARTMENT
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473
Mailing Address - Country:US
Mailing Address - Phone:203-239-5321
Mailing Address - Fax:
Practice Address - Street 1:11 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473
Practice Address - Country:US
Practice Address - Phone:203-239-5321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF NORTH HAVEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-08
Last Update Date:2022-03-11
Deactivation Date:2022-02-18
Deactivation Code:
Reactivation Date:2022-03-11
Provider Licenses
StateLicense IDTaxonomies
CTC101P1207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty