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General NPI Number Information
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NPI Number | 1982923397
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Entity Type | Organization
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Legal Business Name | PORT JEFFERSON VOLUNTEER AMBULANCE INC
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Dates
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Enumeration Date | 05/25/2010
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 25 CRYSTAL BROOK HOLLOW RD
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City | MOUNT SINAI
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State | NY
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Zip | 11766-1612
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Country | US
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Telephone | 631-473-2519
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Fax | 631-476-6716
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Provider Business Mailing Address
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Address Line | PO BOX 264
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-0264
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Country | US
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Telephone | 631-473-2519
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Fax | 631-476-6716
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Authorized Official
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Title or Position | CHIEF OF TRAINING
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Name | JASON LAZERUS
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Credential | EMT-CC
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Telephone | 631-473-2519
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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 |
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License Number State |
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