Provider Demographics
NPI:1073546206
Name:PHOENIX TRANSPORT CORPORATION DBA
Entity Type:Organization
Organization Name:PHOENIX TRANSPORT CORPORATION DBA
Other - Org Name:EMERGENCY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTORANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-972-9224
Mailing Address - Street 1:350 MOTOR PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-5101
Mailing Address - Country:US
Mailing Address - Phone:866-972-9224
Mailing Address - Fax:845-897-1090
Practice Address - Street 1:1580 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1916
Practice Address - Country:US
Practice Address - Phone:631-244-0280
Practice Address - Fax:631-244-0286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10122341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02099470Medicaid
NYA43781Medicare ID - Type UnspecifiedPROVIDER NUMBER