Provider Demographics
NPI:1104105022
Name:FALCK NORTHEAST CORP.
Entity type:Organization
Organization Name:FALCK NORTHEAST CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-868-6668
Mailing Address - Street 1:PO BOX 827299
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-7299
Mailing Address - Country:US
Mailing Address - Phone:800-864-7523
Mailing Address - Fax:410-247-4856
Practice Address - Street 1:1101 E RIDGE PIKE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2720
Practice Address - Country:US
Practice Address - Phone:800-864-7523
Practice Address - Fax:410-247-4856
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FALCK EMS CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-09
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA09025341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA236994Medicare PIN