Healthcare Provider Details

I. General information

NPI: 1164410536
Provider Name (Legal Business Name): RIDGEWOOD VOLUNTEER AMBULANCE CORPS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 ONDERDONK AVE.
RIDGEWOOD NY
11385-1862
US

IV. Provider business mailing address

503 ONDERDONK AVE.
RIDGEWOOD NY
11385-1862
US

V. Phone/Fax

Practice location:
  • Phone: 718-386-7230
  • Fax: 718-386-7230
Mailing address:
  • Phone: 718-386-7230
  • Fax: 718-386-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number7368
License Number StateNY

VIII. Authorized Official

Name: MR. KEVIN M. MAHONEY
Title or Position: CHAIRMAN
Credential: EMT
Phone: 718-386-7230