Provider Demographics
NPI:1508115031
Name:GALAXY AMBULANCE LLC
Entity Type:Organization
Organization Name:GALAXY AMBULANCE LLC
Other - Org Name:GALAXY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVRIKH
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ASHUROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-596-5222
Mailing Address - Street 1:110 MAIN ST STE 303
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-1376
Mailing Address - Country:US
Mailing Address - Phone:800-596-5222
Mailing Address - Fax:877-596-5011
Practice Address - Street 1:110 MAIN ST STE 303
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1376
Practice Address - Country:US
Practice Address - Phone:800-596-5222
Practice Address - Fax:877-596-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1212074341600000X, 3416L0300X, 343800000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)