Provider Demographics
NPI:1174683056
Name:NORTH SHORE AMBULANCE&OXYGEN SERVICE INC
Entity Type:Organization
Organization Name:NORTH SHORE AMBULANCE&OXYGEN SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:TUFARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-458-9300
Mailing Address - Street 1:11018 CORONA AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4029
Mailing Address - Country:US
Mailing Address - Phone:718-458-9300
Mailing Address - Fax:718-699-4321
Practice Address - Street 1:11018 CORONA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4029
Practice Address - Country:US
Practice Address - Phone:718-458-9300
Practice Address - Fax:718-699-4321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73603416L0300X
NYB90162343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00321673Medicaid
NY00321673Medicaid