Healthcare Provider Details

I. General information

NPI: 1093049504
Provider Name (Legal Business Name): GREENWOOD LAKE AMBULANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 WINDERMERE AVE
GREENWOOD LAKE NY
10925-0223
US

IV. Provider business mailing address

74 WINDERMERE AVE P.O. BOX 223
GREENWOOD LAKE NY
10925-0223
US

V. Phone/Fax

Practice location:
  • Phone: 845-477-2200
  • Fax:
Mailing address:
  • Phone: 845-477-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number03520
License Number StateNY

VIII. Authorized Official

Name: MS. EILEEN C DIFFLEY
Title or Position: PRESIDENT
Credential:
Phone: 845-721-5682