Healthcare Provider Details

I. General information

NPI: 1114901790
Provider Name (Legal Business Name): IRVINGTON VOLUNTEER AMBULANCE CORPS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MAIN ST
IRVINGTON NY
10533-1719
US

IV. Provider business mailing address

PO BOX 535
BALDWINSVILLE NY
13027-0535
US

V. Phone/Fax

Practice location:
  • Phone: 914-591-5151
  • Fax:
Mailing address:
  • Phone: 315-635-1789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number10375
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: LUCAS ISOLA
Title or Position: CAPTAIN
Credential:
Phone: 914-591-5151