Healthcare Provider Details

I. General information

NPI: 1487671095
Provider Name (Legal Business Name): PINE BUSH AREA AMBULANCE CORPS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 CENTER ST
PINE BUSH NY
12566-0000
US

IV. Provider business mailing address

PO BOX 535
BALDWINSVILLE NY
13027-0535
US

V. Phone/Fax

Practice location:
  • Phone: 845-744-5391
  • Fax:
Mailing address:
  • Phone: 315-635-1789
  • Fax: 315-635-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number09770
License Number StateNY

VIII. Authorized Official

Name: BRETT COHEN
Title or Position: CAPTAIN/CHIEF OPERATIONS OFFICER
Credential:
Phone: 845-590-4537