1639272297 NPI number — EXCLUSIVE AMBULETTE SERVICE, INC.

Table of content: (NPI 1639272297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639272297 NPI number — EXCLUSIVE AMBULETTE SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCLUSIVE AMBULETTE SERVICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639272297
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 LAWRENCE AVE
Provider Second Line Business Mailing Address:
P.O. BOX 476
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11559-1446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-327-5500
Provider Business Mailing Address Fax Number:
718-337-6544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 BEACH 21ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAR ROCKAWAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11691-3612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-327-5500
Provider Business Practice Location Address Fax Number:
718-337-6544
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EDELMAN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
718-327-5500

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  01463827 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01463827 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: AMB000300 . This is a "VNS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com