Provider Demographics
NPI:1063402527
Name:OLD SAYBROOK AMBULANCE ASSN INC.
Entity type:Organization
Organization Name:OLD SAYBROOK AMBULANCE ASSN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:860-388-9889
Mailing Address - Street 1:195 ROUTE 80
Mailing Address - Street 2:
Mailing Address - City:KILLINGWORTH
Mailing Address - State:CT
Mailing Address - Zip Code:06419
Mailing Address - Country:US
Mailing Address - Phone:860-257-9201
Mailing Address - Fax:860-721-6362
Practice Address - Street 1:316 MAIN STREET
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475
Practice Address - Country:US
Practice Address - Phone:860-388-0161
Practice Address - Fax:860-388-9548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004052981Medicaid
590069808OtherRAILROAD MEDICARE
CT004052981Medicaid