Provider Demographics
NPI:1235298167
Name:PITTSTON TOWNSHIP AMBULANCE ASSOCIATION
Entity type:Organization
Organization Name:PITTSTON TOWNSHIP AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUDZINSKI
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:570-654-4717
Mailing Address - Street 1:24 BRYDEN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3449
Mailing Address - Country:US
Mailing Address - Phone:570-654-4717
Mailing Address - Fax:570-602-6317
Practice Address - Street 1:24 BRYDEN ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3449
Practice Address - Country:US
Practice Address - Phone:570-654-4717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
801322OtherFEDERAL BLACK LUNG
PA0012514080006Medicaid
801322OtherFEDERAL BLACK LUNG