Provider Demographics
NPI:1801003421
Name:WATERFORD TOWNSHIP EMS INC
Entity Type:Organization
Organization Name:WATERFORD TOWNSHIP EMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-306-6525
Mailing Address - Street 1:192 A AVE
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-2434
Mailing Address - Country:US
Mailing Address - Phone:856-306-6525
Mailing Address - Fax:856-767-3660
Practice Address - Street 1:192 A AVE
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-2434
Practice Address - Country:US
Practice Address - Phone:856-306-6525
Practice Address - Fax:856-767-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJWATERF0153416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0059455Medicaid
NJ91000662100OtherAMERICHOICE
NJ1160203OtherHORIZON MERCY
NJ36117OtherHEALTH PARTNERS
NJ2074256000OtherAMERIHEALTH
NJ36117OtherHEALTH PARTNERS
NJ0059455Medicaid