MEDICARE: SHALOM AMBULETTE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	36042	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013116516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHALOM AMBULETTE INC

Provider Business Mailing Address
First Line	:	600 N BROADWAY
Second Line	:	SUITE #218
City	:	WHITE PLAINS
State	:	NY
Zip	:	10603-2466
Country	:	US
Telephone Number	:	914-285-3397
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N BROADWAY
Second Line	:	SUITE #218
City	:	WHITE PLAINS
State	:	NY
Zip	:	10603-2466
Country	:	US
Telephone Number	:	914-285-3397
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSE EAPEN
Credential	:
Telephone Number	:	914-285-3397

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	07/13/2007

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