Healthcare Provider Details

I. General information

NPI: 1770264129
Provider Name (Legal Business Name): VILLAGE OF LINDENHURST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S WELLWOOD AVE
LINDENHURST NY
11757-4904
US

IV. Provider business mailing address

225 S WELLWOOD AVE
LINDENHURST NY
11757-4904
US

V. Phone/Fax

Practice location:
  • Phone: 631-957-7530
  • Fax:
Mailing address:
  • Phone: 631-957-7530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALEJANDRO CALAS
Title or Position: EMS SUPERVISOR
Credential:
Phone: 631-957-7530