Provider Demographics
NPI:1992845085
Name:BERKSHIRE EMERGENCY SQUAD INC
Entity Type:Organization
Organization Name:BERKSHIRE EMERGENCY SQUAD INC
Other - Org Name:NORTHERN TIOGA EMERGENCY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GALLUZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-642-3451
Mailing Address - Street 1:8020 E MAIN RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-9704
Mailing Address - Country:US
Mailing Address - Phone:800-716-8015
Mailing Address - Fax:585-768-7323
Practice Address - Street 1:9 PARK STREET
Practice Address - Street 2:SUITE C
Practice Address - City:NEWARK VALLEY
Practice Address - State:NY
Practice Address - Zip Code:13811-0506
Practice Address - Country:US
Practice Address - Phone:607-642-3451
Practice Address - Fax:607-642-5036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06803416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02368069Medicaid
NYDD2274Medicare UPIN
NY02368069Medicaid