Organization
JEFFERSON TOWNSHIP VOLUNTEER AMBULANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL CORALLO (CAPTAIN)
(570) 840-4057
Entity
Organization
Contact information
Practice address
1980 MOOSIC LAKE RD, JEFFERSON TOWNSHIP, PA 18436-3203
(570) 698-0479
(570) 689-4703
Mailing address
PO BOX 1846, SHAVERTOWN, PA 18708-0846
(570) 477-1900
(570) 608-4015
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
98322
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012569140002
—
PA
Enumeration date
12/11/2006
Last updated
04/02/2020
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