Healthcare Provider Details

I. General information

NPI: 1659302149
Provider Name (Legal Business Name): PHILADELPHIA AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13440 DAMAR DR SUITE G
PHILADELPHIA PA
19116-1817
US

IV. Provider business mailing address

13440 DAMAR DR SUITE G
PHILADELPHIA PA
19116-1817
US

V. Phone/Fax

Practice location:
  • Phone: 215-676-7200
  • Fax: 215-676-2806
Mailing address:
  • Phone: 215-676-7200
  • Fax: 215-676-2806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number03190
License Number StatePA

VIII. Authorized Official

Name: MR. BORIS LEVENZON
Title or Position: VICE PRESIDENT
Credential:
Phone: 215-676-7200