Organization
BROAD CHANNEL VOLUNTEERS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY GENTILE (AUTHORIZED AGENT)
(800) 452-8191
Entity
Organization
Contact information
Practice address
15 NOEL RD, BROAD CHANNEL, NY 11693-1037
(718) 474-6888
(718) 474-6888
Mailing address
PO BOX 290184, WETHERSFIELD, CT 06129-0184
(800) 452-8191
(860) 721-6362
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
7340
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01668060
—
NY
01
—
1679561112
RAILROAD MEDICARE
NY
Enumeration date
10/10/2005
Last updated
10/14/2008
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