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General NPI Number Information
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NPI Number | 1568004208
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Entity Type | Organization
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Legal Business Name | MANORVILLE COMMUNITY AMBULANCE INC
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 184 SOUTH ST
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City | MANORVILLE
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State | NY
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Zip | 11949-3051
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Country | US
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Telephone | 631-278-2140
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Fax |
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Provider Business Mailing Address
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Address Line | 184 SOUH STREET
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City | MANORVILLE
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State | NY
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Zip | 11949
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Country | US
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Telephone | 631-278-2140
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Fax |
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Authorized Official
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Title or Position | ASSISTANT CHIEF
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Name | NICHOLAS CAPORUSSO
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Credential |
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Telephone | 631-278-2140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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