Provider Demographics
NPI:1043301914
Name:ALL ISLAND AMBULETTE
Entity Type:Organization
Organization Name:ALL ISLAND AMBULETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GENADIY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDURAHMANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-903-2086
Mailing Address - Street 1:1250 ST. LOUIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-666-7700
Mailing Address - Fax:
Practice Address - Street 1:1250 ST. LOUIS AVENUE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-666-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02663629343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01218280Medicaid
NY02663629Medicaid