MEDICARE: VIRGO 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)	30801	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	:	1982856845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGO AMBULETTE INC

Provider Business Mailing Address
First Line	:	13 KALMIA LN
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11581-2325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 KALMIA LN VALLEY SREAM NY 11581
Second Line	:	4222 AVE I
City	:	BROOKLYN
State	:	NY
Zip	:	11581
Country	:	US
Telephone Number	:	718-677-0317
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH ALIX PORTES
Credential	:
Telephone Number	:	718-677-0317

Provider Enumeration Date	:	10/22/2008
Last Update Date	:	10/22/2008

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