MEDICARE: MOHEGAN VOLUNTEER FIRE ASSOCIATION VOLUNTEER AMBULANCE CORPS 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	341600000X	Ambulance	10366	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590013205	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	9634358	OTHER	GHI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	900951	OTHER	MVP

General Provider Information

NPI Number	:	1639132905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOHEGAN VOLUNTEER FIRE ASSOCIATION VOLUNTEER AMBULANCE CORPS INC

Provider Business Mailing Address
First Line	:	PO BOX 21027
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-1027
Country	:	US
Telephone Number	:	914-526-1005
Fax Number	:

Provider Business Practice Location Address
First Line	:	1975 EAST MAIN ST
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547
Country	:	US
Telephone Number	:	914-526-1005
Fax Number	:	914-526-1048

Authorized Official
Title or Position	:	CHAIRPERSON
Name	:	KENNETH CHODKOWSKI
Credential	:
Telephone Number	:	914-526-1005

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	06/03/2025

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