North East Advanced Life Support, LLC

Primary specialty

AmbulanceTaxonomy code 341600000X

License

0849 Issued in NY

Legal business name

NORTH EAST ADVANCED LIFE SUPPORT, LLC

Practice address

4 Cortland Dr
Albany, NY 12211-1319

Phone

(888) 603-2455

Fax

(888) 603-2455

NPI assigned

Nov 6, 2007

Last updated

Nov 6, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Christian P Bodner

Title

Chief Executive Officer

Phone

(518) 273-2705

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194307200000",
    "number": "1174703383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 CORTLAND DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122111319",
            "telephone_number": "888-603-2455",
            "fax_number": "888-603-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 CORTLAND DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122111319",
            "telephone_number": "888-603-2455",
            "fax_number": "888-603-2455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH EAST ADVANCED LIFE SUPPORT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-06",
        "last_updated": "2007-11-06",
        "status": "A",
        "authorized_official_last_name": "BODNER",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "518-273-2705",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "NY",
            "license": "0849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulance in Albany, NY
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• Ambulance in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2007; 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.