North Shore Volunteer Emergency Squad Inc

Primary specialty

AmbulanceTaxonomy code 341600000X

License

10621 Issued in NY

Legal business name

NORTH SHORE VOLUNTEER EMERGENCY SQUAD INC

Practice address

136 Bridge St
Cleveland, NY 13042

Phone

(315) 675-3110

NPI assigned

Jun 21, 2006

Organization subpart

No

Name

Diane Avery

Title

Treasurer

Phone

(315) 635-1789

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 27, 2012.

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343347200000",
    "number": "1104862887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 535",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "130270535",
            "telephone_number": "315-635-1789",
            "fax_number": "315-635-3289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 BRIDGE ST",
            "city": "CLEVELAND",
            "state": "NY",
            "postal_code": "13042",
            "telephone_number": "315-675-3110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE VOLUNTEER EMERGENCY SQUAD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2012-07-27",
        "status": "A",
        "authorized_official_last_name": "AVERY",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "315-635-1789"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "NY",
            "license": "10621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01828757",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "318534",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "590012354",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Syeda Zahra Batool Gardezi, MD
• Jo Ann Elizabeth Marsala-Goettel, PT
• Lisa Lynn Miller, LPN
• Kevin Montross, RN
• Chance Nickerson
• Jill Ryan
• Colleen Smith, RN
• Christine M Tancredi, NP
• Angela S Whitby, PSYD
• Theresa Jean White, LPN

• All providers in Cleveland, NY
• Ambulance in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.