Provider Demographics
NPI:1164522017
Name:CENTURY AMBULANCE SERVICE ORG,
Entity Type:Organization
Organization Name:CENTURY AMBULANCE SERVICE ORG,
Other - Org Name:CENTURY ONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMENICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-235-9000
Mailing Address - Street 1:722 NEPPERHAN AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2312
Mailing Address - Country:US
Mailing Address - Phone:877-367-7717
Mailing Address - Fax:914-798-9796
Practice Address - Street 1:8730 123RD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2731
Practice Address - Country:US
Practice Address - Phone:718-235-9000
Practice Address - Fax:718-235-9867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73423416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00321004Medicaid
NY2008072026Medicare NSC