MEDICARE: BEDFORD STUYVESANT VOL AMB

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	3416L0300X	Land Ambulance	7143	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	:	1467440834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEDFORD STUYVESANT VOL AMB

Provider Business Mailing Address
First Line	:	PO BOX 290184
Second Line	:
City	:	WETHERSFIELD
State	:	CT
Zip	:	06129-0184
Country	:	US
Telephone Number	:	800-452-8191
Fax Number	:	860-721-6362

Provider Business Practice Location Address
First Line	:	561 LEXINGTON AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-1807
Country	:	US
Telephone Number	:	718-453-4617
Fax Number	:	718-562-7316

Authorized Official
Title or Position	:	AUTHORIZED AGENT
Name	:	MS. HEATHER M LIZOTTE
Credential	:
Telephone Number	:	800-452-8191

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	08/22/2020

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