Healthcare Provider Details

I. General information

NPI: 1689664146
Provider Name (Legal Business Name): PHILIPSTOWN VOLUNTEER AMBULANCE CORPS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CEDAR ST
COLD SPRING NY
10516-1901
US

IV. Provider business mailing address

PO BOX 290184
WETHERSFIELD CT
06129-0184
US

V. Phone/Fax

Practice location:
  • Phone: 845-265-2103
  • Fax:
Mailing address:
  • Phone: 860-257-9201
  • Fax: 860-563-3403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number3916
License Number StateNY

VIII. Authorized Official

Name: MRS. MARY T GENTILE
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 860-257-9201