Provider Demographics
NPI:1235188830
Name:CITY OF PLEASANTVILLE
Entity Type:Organization
Organization Name:CITY OF PLEASANTVILLE
Other - Org Name:PLEASANTVILLE EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-484-3667
Mailing Address - Street 1:1 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2603
Mailing Address - Country:US
Mailing Address - Phone:609-484-3667
Mailing Address - Fax:609-569-1732
Practice Address - Street 1:1 N 1ST ST
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-2603
Practice Address - Country:US
Practice Address - Phone:609-484-3667
Practice Address - Fax:609-569-1732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2008-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNONE3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ90000580400OtherAMERICHOICE
NJ7661703Medicaid
NJ0684050000OtherAMERIHEALTH
NJ20045896OtherAMERIHEALTH MERCY HLT PLN
NJ1076644OtherKEYSTONE MERCY HEALTH PLN
NJ7661703Medicaid
NJ20045896OtherAMERIHEALTH MERCY HLT PLN
NJ1076644OtherKEYSTONE MERCY HEALTH PLN
NJ=========OtherHORIZON BLUE SHIELD
NJ7661703Medicaid
NJ=========OtherCIGNA