Provider Demographics
NPI:1851467971
Name:GREENPORT RESCUE SQUAD, INC
Entity Type:Organization
Organization Name:GREENPORT RESCUE SQUAD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:D
Authorized Official - Last Name:MERANTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:518-822-8511
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-4040
Mailing Address - Country:US
Mailing Address - Phone:518-822-8511
Mailing Address - Fax:518-822-0047
Practice Address - Street 1:3 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-4040
Practice Address - Country:US
Practice Address - Phone:518-822-8511
Practice Address - Fax:518-822-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10133416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10015395OtherCDPHP
NY01199155Medicaid
NY10015395OtherCDPHP