Provider Demographics
NPI:1639158843
Name:KEARNY VOLUNTEER EMERGENCY RESCUE SQUAD
Entity Type:Organization
Organization Name:KEARNY VOLUNTEER EMERGENCY RESCUE SQUAD
Other - Org Name:KEARNY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-991-5704
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-0419
Mailing Address - Country:US
Mailing Address - Phone:201-991-5704
Mailing Address - Fax:201-997-1021
Practice Address - Street 1:352 MAPLE ST
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2125
Practice Address - Country:US
Practice Address - Phone:201-991-5704
Practice Address - Fax:201-997-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJKEAR002993416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0041823Medicaid
NJ224609Medicare ID - Type Unspecified