Provider Demographics
NPI:1275662462
Name:LODI VOLUNTEER AMBULANCE RESCUE SQUAD, INC.
Entity Type:Organization
Organization Name:LODI VOLUNTEER AMBULANCE RESCUE SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAORMINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-546-1069
Mailing Address - Street 1:P.O. BOX 299
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644
Mailing Address - Country:US
Mailing Address - Phone:973-546-1069
Mailing Address - Fax:973-478-0501
Practice Address - Street 1:72 KIMMIG AVENUE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-1418
Practice Address - Country:US
Practice Address - Phone:973-546-3488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
NJL02110363416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0129330Medicaid
NJ110502Medicare PIN