Provider Demographics
NPI:1407498264
Name:MASTIC BEACH AMBULANCE COMPANY INC
Entity Type:Organization
Organization Name:MASTIC BEACH AMBULANCE COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-831-9838
Mailing Address - Street 1:PO BOX 523
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-0523
Mailing Address - Country:US
Mailing Address - Phone:631-831-9838
Mailing Address - Fax:
Practice Address - Street 1:343 MAIN ST
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-3415
Practice Address - Country:US
Practice Address - Phone:631-831-9838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-14
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport