=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043285133
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LENAPE VOLUNTEER AMBULANCE CORPS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2006
-----------------------------------------------------
Last Update Date | 04/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 129 STATE RT 284
-----------------------------------------------------
City | UNIONVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-726-3298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 535
-----------------------------------------------------
City | BALDWINSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13027-0535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-635-1789
-----------------------------------------------------
Fax | 315-635-3289
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | THERESA A REYNOLDS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-726-4112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 09634
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------