Provider Demographics
NPI:1003078908
Name:ANGEL CARE AMBULETTE CORP
Entity Type:Organization
Organization Name:ANGEL CARE AMBULETTE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:AMARUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-846-4888
Mailing Address - Street 1:PO BOX 1341
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-0896
Mailing Address - Country:US
Mailing Address - Phone:631-846-4888
Mailing Address - Fax:631-337-4175
Practice Address - Street 1:353 KNICKERBOCKER AVE
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-3103
Practice Address - Country:US
Practice Address - Phone:631-846-4888
Practice Address - Fax:631-337-4175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY37205343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)