Provider Demographics
NPI:1114901790
Name:IRVINGTON VOLUNTEER AMBULANCE CORPS INC
Entity Type:Organization
Organization Name:IRVINGTON VOLUNTEER AMBULANCE CORPS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-591-5151
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:315-635-1789
Mailing Address - Fax:
Practice Address - Street 1:80 MAIN ST
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-1719
Practice Address - Country:US
Practice Address - Phone:914-591-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10375341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
590009536OtherPALMETTO GBA RAILROAD
NY01581786Medicaid
9610523OtherGHI
602651OtherMVP
NYA01471Medicare ID - Type Unspecified