Provider Demographics
NPI:1003843814
Name:NORTHEASTERN AMBULANCE SERVICE LLC
Entity Type:Organization
Organization Name:NORTHEASTERN AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GEBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-677-5906
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027
Mailing Address - Country:US
Mailing Address - Phone:315-635-1789
Mailing Address - Fax:315-635-3289
Practice Address - Street 1:206 BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:NY
Practice Address - Zip Code:12887
Practice Address - Country:US
Practice Address - Phone:516-677-5906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10289341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
951635OtherMVP
NY01556656Medicaid
NY55508BMedicare ID - Type Unspecified