Provider Demographics
NPI:1003804477
Name:BAYSIDE COMMUNITY AMBULANCE CORPS INC
Entity Type:Organization
Organization Name:BAYSIDE COMMUNITY AMBULANCE CORPS INC
Other - Org Name:BAYSIDE VOLUNTEER AMBULANCE CORPS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-631-3333
Mailing Address - Street 1:PO BOX 610606
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-0606
Mailing Address - Country:US
Mailing Address - Phone:718-631-3333
Mailing Address - Fax:
Practice Address - Street 1:21429 42ND AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2917
Practice Address - Country:US
Practice Address - Phone:718-631-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2023-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01778298Medicaid
NY01778298Medicaid