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General NPI Number Information
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NPI Number | 1679019541
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Entity Type | Organization
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Legal Business Name | LUCKY AMBULETTE SERVICES
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Dates
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Enumeration Date | 01/16/2017
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Last Update Date | 01/16/2017
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Provider Practice Location Address
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Address Line | 205 GIBBS POND RD
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City | NESCONSET
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State | NY
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Zip | 11767-2265
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Country | US
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Telephone | 631-432-9691
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Fax | 631-257-5866
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Provider Business Mailing Address
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Address Line | 205 GIBBS POND RD
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City | NESCONSET
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State | NY
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Zip | 11767-2265
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Country | US
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Telephone | 631-432-9691
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Fax | 631-257-5866
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Authorized Official
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Title or Position | PRESIDENT
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Name | LUCKO JEAN
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Credential |
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Telephone | 631-741-1895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 39758
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License Number State | NY
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