Organization
RAQUETTE LAKE FIRE DEPARTMENT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY T GENTILE (AUTHORIZED AGENT)
(860) 257-9201
Entity
Organization
Contact information
Practice address
171 ROUTE 28, RAQUETTE LAKE, NY 13436-0160
(315) 354-4644
(315) 354-5069
Mailing address
PO BOX 290184, WETHERSFIELD, CT 06129-0184
(860) 257-9201
(860) 721-6362
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
2017
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00076421
RAILROAD MEDICARE
—
Enumeration date
10/26/2005
Last updated
04/15/2010
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