Provider Demographics
NPI:1528212537
Name:BOROUGH OF FORT LEE
Entity Type:Organization
Organization Name:BOROUGH OF FORT LEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAVIA
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:201-592-3637
Mailing Address - Street 1:20 E TAUNTON RD STE 500
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-2615
Mailing Address - Country:US
Mailing Address - Phone:866-476-1702
Mailing Address - Fax:609-481-2270
Practice Address - Street 1:309 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4705
Practice Address - Country:US
Practice Address - Phone:201-347-2114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0223859Medicaid
NJ140590Medicare PIN