Provider Demographics
NPI:1295040459
Name:AVA AMBULETTE CORP
Entity Type:Organization
Organization Name:AVA AMBULETTE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VISE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARSENYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-975-2000
Mailing Address - Street 1:1811 STILLWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2419
Mailing Address - Country:US
Mailing Address - Phone:718-975-2000
Mailing Address - Fax:718-975-1999
Practice Address - Street 1:1811 STILLWELL AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2419
Practice Address - Country:US
Practice Address - Phone:718-975-2000
Practice Address - Fax:718-975-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB90685343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03218251Medicaid