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General NPI Number Information
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NPI Number | 1568450906
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Entity Type | Organization
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Legal Business Name | WANTAGH LEVITTOWN VOL AMB CORPS
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 129 BALSAM LN
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City | LEVITTOWN
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State | NY
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Zip | 11756-4901
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Country | US
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Telephone | 516-520-3002
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Fax | 516-731-3411
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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 | 800-452-8191
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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. HEATHER M LIZOTTE
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Credential |
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Telephone | 800-452-8191
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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 | 2933
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License Number State | NY
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