Provider Demographics
NPI:1376988386
Name:ATLAS AMBULETTE INC
Entity Type:Organization
Organization Name:ATLAS AMBULETTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEUNGRAK
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-776-3314
Mailing Address - Street 1:120-16 KETCH COURT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356
Mailing Address - Country:US
Mailing Address - Phone:718-776-3314
Mailing Address - Fax:718-776-3315
Practice Address - Street 1:120-16 KETCH COURT
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356
Practice Address - Country:US
Practice Address - Phone:718-776-3314
Practice Address - Fax:718-776-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36622343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02857596Medicaid