Provider Demographics
NPI:1518105766
Name:NUTLEY EMERGENCY RESCUE
Entity Type:Organization
Organization Name:NUTLEY EMERGENCY RESCUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALPHONSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRACCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-284-4935
Mailing Address - Street 1:1 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2786
Mailing Address - Country:US
Mailing Address - Phone:973-284-4935
Mailing Address - Fax:973-284-4920
Practice Address - Street 1:1 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2786
Practice Address - Country:US
Practice Address - Phone:973-284-4935
Practice Address - Fax:973-284-4920
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWNSHIP OF NUTLEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3416L0300X3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport