Provider Demographics
NPI:1235845124
Name:PINE ISLAND VOLUNTEER AMBULANCE CORPS, INC.
Entity Type:Organization
Organization Name:PINE ISLAND VOLUNTEER AMBULANCE CORPS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIKUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-258-4122
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:PINE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10969-0264
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:679 COUNTY ROUTE 1
Practice Address - Street 2:
Practice Address - City:PINE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10969-1718
Practice Address - Country:US
Practice Address - Phone:845-258-4122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance