=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164522017
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTURY AMBULANCE SERVICE ORG,
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 02/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8730 123RD ST
-----------------------------------------------------
City | RICHMOND HILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11418-2731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-235-9000
-----------------------------------------------------
Fax | 718-235-9867
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 722 NEPPERHAN AVE
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10703-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-367-7717
-----------------------------------------------------
Fax | 914-798-9796
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | DOMENICK MARINARO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-235-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 7342
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------