Healthcare Provider Details

I. General information

NPI: 1003843814
Provider Name (Legal Business Name): NORTHEASTERN AMBULANCE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BROADWAY
WHITEHALL NY
12887
US

IV. Provider business mailing address

PO BOX 535
BALDWINSVILLE NY
13027
US

V. Phone/Fax

Practice location:
  • Phone: 516-677-5906
  • 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 Number10289
License Number StateNY

VIII. Authorized Official

Name: JOHN H GEBO
Title or Position: CO OWNER
Credential:
Phone: 518-677-5906