MEDICARE: JAMAICA ESTATES HOLLISWOOD SOUTH BAYSIDE VOLUNTEER AMBULANCE CORP

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	341600000X	Ambulance	7381	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1386634848	OTHER	NY	RAILROAD MEDICARE

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	:	1386634848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMAICA ESTATES HOLLISWOOD SOUTH BAYSIDE VOLUNTEER AMBULANCE CORP

Provider Business Mailing Address
First Line	:	PO BOX 290184
Second Line	:
City	:	WETHERSFIELD
State	:	CT
Zip	:	06129-0184
Country	:	US
Telephone Number	:	860-257-9201
Fax Number	:	860-721-6362

Provider Business Practice Location Address
First Line	:	207 07 UNION TURNPIKE
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11364-3234
Country	:	US
Telephone Number	:	718-464-0592
Fax Number	:	917-644-1924

Authorized Official
Title or Position	:	AUTHORIZED AGENT
Name	:	MS. MARY T GENTILE
Credential	:
Telephone Number	:	860-257-9201

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	02/06/2009

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Directions to “JAMAICA ESTATES HOLLISWOOD SOUTH BAYSIDE VOLUNTEER AMBULANCE CORP ” Practice Location

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