Provider Demographics
NPI:1376764217
Name:OCEAN AMBULETTE SERV INC
Entity Type:Organization
Organization Name:OCEAN AMBULETTE SERV INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:POLYAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-946-1000
Mailing Address - Street 1:3072 BRIGHTON 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-946-1000
Mailing Address - Fax:718-946-0865
Practice Address - Street 1:3072 BRIGHTON 1ST STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-946-1000
Practice Address - Fax:718-946-0865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB90357343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB90357OtherT & LC
NY30788OtherDOT
NY01064942Medicaid