Healthcare Provider Details

I. General information

NPI: 1093825648
Provider Name (Legal Business Name): MEDICAL EXPRESS AMBULANCE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 FREEMAN ST
BRONX NY
10459-2102
US

IV. Provider business mailing address

1028 FREEMAN ST
BRONX NY
10459-2102
US

V. Phone/Fax

Practice location:
  • Phone: 718-617-1522
  • Fax: 718-617-1262
Mailing address:
  • Phone: 718-617-1522
  • Fax: 718-617-1262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0573
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number34801
License Number StateNY

VIII. Authorized Official

Name: MR. JOHN M. LAUINGER
Title or Position: VICE PRESIDENT
Credential:
Phone: 718-617-1522