=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093284499
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL ISLIP-HAUPPAUGE VOLUNTEER AMBULANCE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2018
-----------------------------------------------------
Last Update Date | 01/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 PINEVILLE ROAD
-----------------------------------------------------
City | CENTRAL ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11722-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-582-4414
-----------------------------------------------------
Fax | 631-582-2615
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 PINEVILLE RD
-----------------------------------------------------
City | CENTRAL ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11722-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-582-4414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BOARD CHAIRMAN
-----------------------------------------------------
Name | PAUL V. RYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 631-582-4414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------