Provider Demographics
NPI:1457595985
Name:BOROUGH OF MAYWOOD
Entity Type:Organization
Organization Name:BOROUGH OF MAYWOOD
Other - Org Name:MAYWOOD EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:BOROUGH ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-845-2900
Mailing Address - Street 1:15 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-2015
Mailing Address - Country:US
Mailing Address - Phone:201-845-2900
Mailing Address - Fax:201-909-0673
Practice Address - Street 1:15 PARK AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-2015
Practice Address - Country:US
Practice Address - Phone:201-845-2900
Practice Address - Fax:201-909-0673
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOROUGH OF MAYWOOD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-28
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJM02110403416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0197220Medicaid
NJ161422Medicare UPIN