Healthcare Provider Details

I. General information

NPI: 1003804477
Provider Name (Legal Business Name): BAYSIDE COMMUNITY AMBULANCE CORPS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 04/15/2023
Certification Date: 04/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21429 42ND AVE
BAYSIDE NY
11361-2917
US

IV. Provider business mailing address

PO BOX 610606
BAYSIDE NY
11361-0606
US

V. Phone/Fax

Practice location:
  • Phone: 718-631-3333
  • Fax:
Mailing address:
  • Phone: 718-631-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER CAPO
Title or Position: PRESIDENT
Credential:
Phone: 718-631-3333