Provider Demographics
NPI:1174703383
Name:NORTH EAST ADVANCED LIFE SUPPORT, LLC
Entity type:Organization
Organization Name:NORTH EAST ADVANCED LIFE SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BODNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-273-2705
Mailing Address - Street 1:4 CORTLAND DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1319
Mailing Address - Country:US
Mailing Address - Phone:888-603-2455
Mailing Address - Fax:888-603-2455
Practice Address - Street 1:4 CORTLAND DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12211-1319
Practice Address - Country:US
Practice Address - Phone:888-603-2455
Practice Address - Fax:888-603-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0849341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance