Healthcare Provider Details

I. General information

NPI: 1073546206
Provider Name (Legal Business Name): PHOENIX TRANSPORT CORPORATION DBA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 OCEAN AVE
BOHEMIA NY
11716-1916
US

IV. Provider business mailing address

350 MOTOR PKWY SUITE 300
HAUPPAUGE NY
11788-5101
US

V. Phone/Fax

Practice location:
  • Phone: 631-244-0280
  • Fax: 631-244-0286
Mailing address:
  • Phone: 866-972-9224
  • Fax: 845-897-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number10122
License Number StateNY

VIII. Authorized Official

Name: JOHN MARTORANO
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 866-972-9224