Healthcare Provider Details

I. General information

NPI: 1164886164
Provider Name (Legal Business Name): ON TIME AMBULETTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1073 ATLANTIC ST
FRANKLIN SQUARE NY
11010-2811
US

IV. Provider business mailing address

1073 ATLANTIC ST
FRANKLIN SQUARE NY
11010-2811
US

V. Phone/Fax

Practice location:
  • Phone: 516-233-1931
  • Fax: 516-502-4578
Mailing address:
  • Phone: 516-233-1931
  • Fax: 516-502-4578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number02899741
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number02899741
License Number StateNY

VIII. Authorized Official

Name: MR. JULIAN JOSE CORDON
Title or Position: PRESIDENT
Credential:
Phone: 516-233-1931