MEDICARE: DEPENDABLE 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)	02022888	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	:	1255312369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPENDABLE AMBULETTE, INC

Provider Business Mailing Address
First Line	:	2 HORTON AVE
Second Line	:	2ND FLOOR
City	:	VALLEY STREAM
State	:	NY
Zip	:	11581-1419
Country	:	US
Telephone Number	:	516-596-0830
Fax Number	:	516-568-2976

Provider Business Practice Location Address
First Line	:	2 HORTON AVE
Second Line	:	2ND FLOOR
City	:	VALLEY STREAM
State	:	NY
Zip	:	11581-1419
Country	:	US
Telephone Number	:	516-596-0830
Fax Number	:	516-568-2976

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. YAN GVINTER
Credential	:
Telephone Number	:	516-596-0830

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	08/22/2020

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