Provider Demographics
NPI:1447469689
Name:PEARL RIVER ALUMNI AMBULANCE CORPORATION
Entity type:Organization
Organization Name:PEARL RIVER ALUMNI AMBULANCE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HADELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-735-2066
Mailing Address - Street 1:PO BOX 1046
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-0346
Mailing Address - Country:US
Mailing Address - Phone:845-228-3112
Mailing Address - Fax:845-627-6728
Practice Address - Street 1:15 N PEARL ST
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2147
Practice Address - Country:US
Practice Address - Phone:845-228-3112
Practice Address - Fax:845-627-6728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4318OtherNYS EMS ID
NYA00081Medicare ID - Type Unspecified