Provider Demographics
NPI:1609859883
Name:CHATHAM RESCUE SQUAD INC
Entity Type:Organization
Organization Name:CHATHAM RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-938-1108
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:315-635-1789
Mailing Address - Fax:
Practice Address - Street 1:11 MOORE AVE
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12037-1424
Practice Address - Country:US
Practice Address - Phone:518-392-9080
Practice Address - Fax:518-392-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09686341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
000401718001OtherBS OF NORTHEASTERN NY
958075OtherMVP
10014016OtherCDPHP
0005313582OtherAETNA
NY01733797Medicaid
NYA22671Medicare ID - Type Unspecified