MEDICARE: LEGAL AMBULETTE SERVICE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285859538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGAL AMBULETTE SERVICE INC.

Provider Business Mailing Address
First Line	:	757 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4913
Country	:	US
Telephone Number	:	718-859-3100
Fax Number	:	718-859-2047

Provider Business Practice Location Address
First Line	:	757 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4913
Country	:	US
Telephone Number	:	718-859-3100
Fax Number	:	718-859-2047

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID IGOR IOFFE
Credential	:
Telephone Number	:	718-859-3100

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	08/22/2020

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