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General NPI Number Information
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NPI Number | 1386634848
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Entity Type | Organization
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Legal Business Name | JAMAICA ESTATES HOLLISWOOD SOUTH BAYSIDE VOLUNTEER AMBULANCE CORP
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 02/06/2009
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Provider Practice Location Address
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Address Line | 207 07 UNION TURNPIKE
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City | BAYSIDE
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State | NY
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Zip | 11364-3234
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Country | US
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Telephone | 718-464-0592
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Fax | 917-644-1924
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Provider Business Mailing Address
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Address Line | PO BOX 290184
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City | WETHERSFIELD
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State | CT
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Zip | 06129-0184
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Country | US
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Telephone | 860-257-9201
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Fax | 860-721-6362
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Authorized Official
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Title or Position | AUTHORIZED AGENT
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Name | MS. MARY T GENTILE
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Credential |
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Telephone | 860-257-9201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 7381
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License Number State | NY
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