Organization
WF BRUEN EMERGENCY SQUAD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY BUFF CONKLIN (BILLING MGR)
(518) 424-0248
Entity
Organization
Contact information
Practice address
1116 RED MILL RD, RENSSELAER, NY 12144-5503
(518) 477-8243
Mailing address
1116 RED MILL RD, RENSSELAER, NY 12144-5503
(518) 477-8243
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
10455
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000900405000
BLUE SHIELD
NY
05
—
02338810
—
NY
01
—
281000003
MVP
NY
Enumeration date
12/20/2005
Last updated
06/11/2013
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