Provider Demographics
NPI:1316017643
Name:D-J AMBULETTE SERVICE INC
Entity Type:Organization
Organization Name:D-J AMBULETTE SERVICE INC
Other - Org Name:CITICARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLITTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-828-9800
Mailing Address - Street 1:1432 BLONDELL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2615
Mailing Address - Country:US
Mailing Address - Phone:718-828-9800
Mailing Address - Fax:718-828-6796
Practice Address - Street 1:2622 CHESBROUGH AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2625
Practice Address - Country:US
Practice Address - Phone:718-828-9800
Practice Address - Fax:718-828-6796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB01277343900000X
NYB90419343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02139059Medicaid