Provider Demographics
NPI:1154394500
Name:AETNA HOSE, HOOK AND LADDER COMPANY OF NEWARK DELAWARE
Entity type:Organization
Organization Name:AETNA HOSE, HOOK AND LADDER COMPANY OF NEWARK DELAWARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREW COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGALEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-454-3300
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19715-0148
Mailing Address - Country:US
Mailing Address - Phone:302-454-3300
Mailing Address - Fax:302-454-3530
Practice Address - Street 1:31 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-4608
Practice Address - Country:US
Practice Address - Phone:302-454-3300
Practice Address - Fax:302-454-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000578215Medicaid
DE0000578215Medicaid