Provider Demographics
NPI:1730558719
Name:MOUNTAINSIDE RESCUE SQUAD BOROUGH OF MOUNTAINSIDE, N.J.
Entity type:Organization
Organization Name:MOUNTAINSIDE RESCUE SQUAD BOROUGH OF MOUNTAINSIDE, N.J.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:PASTORE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:908-233-6338
Mailing Address - Street 1:1399 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2401
Mailing Address - Country:US
Mailing Address - Phone:908-233-6338
Mailing Address - Fax:908-233-6573
Practice Address - Street 1:1399 ROUTE 22
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2401
Practice Address - Country:US
Practice Address - Phone:908-233-6338
Practice Address - Fax:908-233-6573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2011017341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance