Provider Demographics
NPI:1750487146
Name:BERLIN INTER COMMUNITY AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:BERLIN INTER COMMUNITY AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-753-0808
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-0406
Mailing Address - Country:US
Mailing Address - Phone:732-748-7329
Mailing Address - Fax:732-873-0293
Practice Address - Street 1:PARK AVE AND WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009
Practice Address - Country:US
Practice Address - Phone:732-748-4329
Practice Address - Fax:732-873-0293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0012173Medicaid
NJ048894Medicare ID - Type UnspecifiedEMPIRE MEDICARE