Provider Demographics
NPI:1225028707
Name:ATLANTIC AMBULANCE CORP.
Entity Type:Organization
Organization Name:ATLANTIC AMBULANCE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LENAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-660-3190
Mailing Address - Street 1:475 SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:973-360-0542
Practice Address - Street 1:120 DORSA AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1003
Practice Address - Country:US
Practice Address - Phone:973-535-8500
Practice Address - Fax:973-535-8340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJATLHLTH01341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0054968Medicaid
NJ590015317OtherRAILROAD MEDICARE
NJ590015317OtherRAILROAD MEDICARE