Provider Demographics
NPI:1407162829
Name:HERNANDEZ AMBULETTE CORP
Entity Type:Organization
Organization Name:HERNANDEZ AMBULETTE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARTOLOME
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-285-5265
Mailing Address - Street 1:683 HART ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-3306
Mailing Address - Country:US
Mailing Address - Phone:718-285-5265
Mailing Address - Fax:347-763-1860
Practice Address - Street 1:683 HART ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-3306
Practice Address - Country:US
Practice Address - Phone:718-285-5265
Practice Address - Fax:347-763-1860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB90669343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)