Provider Demographics
NPI:1083051585
Name:TWINS AMBULETTE SERVICE
Entity Type:Organization
Organization Name:TWINS AMBULETTE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATSKELEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-743-2000
Mailing Address - Street 1:2849 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4634
Mailing Address - Country:US
Mailing Address - Phone:718-743-2000
Mailing Address - Fax:718-743-0800
Practice Address - Street 1:2849 86TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223
Practice Address - Country:US
Practice Address - Phone:718-743-2000
Practice Address - Fax:718-743-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB90349343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01381915Medicaid