Provider Demographics
NPI:1316367956
Name:CASSOVIA AMBULANCE LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:CASSOVIA AMBULANCE LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:FORGACS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-666-9990
Mailing Address - Street 1:17 LOTZ HILL RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2312
Mailing Address - Country:US
Mailing Address - Phone:973-666-9990
Mailing Address - Fax:973-779-5998
Practice Address - Street 1:17 LOTZ HILL RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2312
Practice Address - Country:US
Practice Address - Phone:973-666-9990
Practice Address - Fax:973-779-5998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1006593416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport