Provider Demographics
NPI:1770338329
Name:BOROUGH OF MADISON
Entity type:Organization
Organization Name:BOROUGH OF MADISON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:WICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-789-1660
Mailing Address - Street 1:62 KINGS RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2659
Mailing Address - Country:US
Mailing Address - Phone:973-593-3022
Mailing Address - Fax:
Practice Address - Street 1:62 KINGS RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2659
Practice Address - Country:US
Practice Address - Phone:973-593-3021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOROUGH OF MADISON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-18
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport