Provider Demographics
NPI:1326141771
Name:OLD BRIDGE TOWNSHIP EMERGENCY MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:OLD BRIDGE TOWNSHIP EMERGENCY MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:MERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-742-9212
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-4146
Mailing Address - Country:US
Mailing Address - Phone:732-742-9212
Mailing Address - Fax:
Practice Address - Street 1:1 OLD BRIDGE PLZ
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857
Practice Address - Country:US
Practice Address - Phone:732-721-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJAPPLICATION 1213060341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ106320Medicare PIN