Provider Demographics
NPI:1205199353
Name:RICHMOND COUNTY AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:RICHMOND COUNTY AMBULANCE SERVICE, INC.
Other - Org Name:RCA AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIEZER
Authorized Official - Middle Name:C
Authorized Official - Last Name:GEWIRTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-273-7703
Mailing Address - Street 1:1355 CASTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1704
Mailing Address - Country:US
Mailing Address - Phone:718-273-3555
Mailing Address - Fax:718-273-7479
Practice Address - Street 1:1355 CASTLETON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1704
Practice Address - Country:US
Practice Address - Phone:718-273-3555
Practice Address - Fax:718-273-7479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHMOND COUNTY AMBULANCE SERVICE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-22
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02991124Medicaid