Provider Demographics
NPI:1346238714
Name:WOODBURY COMMUNITY AMBULANCE INC
Entity Type:Organization
Organization Name:WOODBURY COMMUNITY AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONQUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-928-6464
Mailing Address - Street 1:5330 SHERIDAN DRIVE
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3730
Mailing Address - Country:US
Mailing Address - Phone:716-204-3350
Mailing Address - Fax:716-634-7170
Practice Address - Street 1:376 ROUTE 32
Practice Address - Street 2:
Practice Address - City:CENTRAL VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10917-3200
Practice Address - Country:US
Practice Address - Phone:845-928-6464
Practice Address - Fax:845-928-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3532341600000X
NY32566341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
590009200OtherRAILROAD MEDICARE
NY01431263Medicaid
590009200OtherRAILROAD MEDICARE