Provider Demographics
NPI:1235113804
Name:JOHNSBURG EMERGENCY SQUAD INC
Entity Type:Organization
Organization Name:JOHNSBURG EMERGENCY SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-812-5282
Mailing Address - Street 1:624 PEACEFUL VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:12853
Mailing Address - Country:US
Mailing Address - Phone:518-251-2244
Mailing Address - Fax:518-251-2257
Practice Address - Street 1:624 PEACEFUL VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:NORTH CREEK
Practice Address - State:NY
Practice Address - Zip Code:12853
Practice Address - Country:US
Practice Address - Phone:518-251-2244
Practice Address - Fax:518-251-2257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09840341600000X
NY341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
000416627001OtherBS OF NORTHEASTERN NY
P00136074OtherPALMETTO GBA RAILROAD
NY02572278Medicaid
NYBA0187OtherMEDICARE PTAN