Provider Demographics
NPI:1477532695
Name:BOROUGH OF ROSELLE
Entity Type:Organization
Organization Name:BOROUGH OF ROSELLE
Other - Org Name:ROSELLE FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MUCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-245-8600
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 1:725 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203
Practice Address - Country:US
Practice Address - Phone:908-245-8600
Practice Address - Fax:908-245-7260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJROSE005053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7131607Medicaid
NJ219416Medicare PIN