MEDICARE: AVA AMBULETTE CORP

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)	B90685	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	:	1295040459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVA AMBULETTE CORP

Provider Business Mailing Address
First Line	:	1811 STILLWELL AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-2419
Country	:	US
Telephone Number	:	718-975-2000
Fax Number	:	718-975-1999

Provider Business Practice Location Address
First Line	:	1811 STILLWELL AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-2419
Country	:	US
Telephone Number	:	718-975-2000
Fax Number	:	718-975-1999

Authorized Official
Title or Position	:	VISE PRESIDENT
Name	:	MR. AMIRAN ARSENYAN
Credential	:
Telephone Number	:	718-975-2000

Provider Enumeration Date	:	08/12/2010
Last Update Date	:	08/12/2010

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Directions to “AVA AMBULETTE CORP ” Practice Location

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