Provider Demographics
NPI:1134117500
Name:VOLUNTEER HEART RESUSCITATION UNIT AND AMBULANCE CORPS OF STATEN ISLA
Entity Type:Organization
Organization Name:VOLUNTEER HEART RESUSCITATION UNIT AND AMBULANCE CORPS OF STATEN ISLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:YIDES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-781-2440
Mailing Address - Street 1:48 BAKERTOWN RD
Mailing Address - Street 2:SUITE 407
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-8428
Mailing Address - Country:US
Mailing Address - Phone:845-781-2440
Mailing Address - Fax:845-781-2424
Practice Address - Street 1:460 BRIELLE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-0252
Practice Address - Country:US
Practice Address - Phone:718-979-5850
Practice Address - Fax:718-979-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7412341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01667505Medicaid
590010159OtherRAILROAD MEDICARE
NY01667505Medicaid