Provider Demographics
NPI:1467432526
Name:GALLOWAY TOWNSHIP AMBULANCE SQUAD, INC
Entity Type:Organization
Organization Name:GALLOWAY TOWNSHIP AMBULANCE SQUAD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-965-4046
Mailing Address - Street 1:PO BOX 784
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NJ
Mailing Address - Zip Code:08240-0784
Mailing Address - Country:US
Mailing Address - Phone:609-965-4046
Mailing Address - Fax:609-804-0332
Practice Address - Street 1:311 CARTON AVE
Practice Address - Street 2:
Practice Address - City:COLOGNE
Practice Address - State:NJ
Practice Address - Zip Code:08213
Practice Address - Country:US
Practice Address - Phone:609-965-4046
Practice Address - Fax:609-804-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGALL002193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7915306Medicaid
NJ7915306Medicaid