Provider Demographics
NPI:1245564467
Name:CRANBURY FIRST AID SQUAD INC
Entity Type:Organization
Organization Name:CRANBURY FIRST AID SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-529-0824
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-0207
Mailing Address - Country:US
Mailing Address - Phone:484-664-2007
Mailing Address - Fax:484-664-2015
Practice Address - Street 1:68 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512-3235
Practice Address - Country:US
Practice Address - Phone:609-395-1707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJC12110113416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0226670Medicaid
NJ166920Medicare PIN