Organization
SKENESBOROUGH EMERGENCY SQUAD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON PAUL SPARKS (CAPTAIN)
(518) 499-2122
Entity
Organization
Contact information
Practice address
37 SKENESBOROUGH DR, WHITEHALL, NY 12887
(315) 499-2122
Mailing address
107 WASHINGTON AVE, ALBANY, NY 12210-2231
(888) 603-2455
(888) 603-2455
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
10696
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000400552001
BCBS OF NENY
—
05
—
01522747
—
NY
05
—
1005602
—
VT
01
—
590009009
PALMETTO-RR MEDICARE
—
01
—
922835
MVP
—
Enumeration date
07/03/2006
Last updated
05/13/2018
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