Provider Demographics
NPI:1760687958
Name:DUANESBURG VOLUNTEER AMBULANCE CORPS INC
Entity Type:Organization
Organization Name:DUANESBURG VOLUNTEER AMBULANCE CORPS INC
Other - Org Name:DUANESBURG AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-895-8169
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:DELANSON
Mailing Address - State:NY
Mailing Address - Zip Code:12053-0130
Mailing Address - Country:US
Mailing Address - Phone:518-895-2200
Mailing Address - Fax:
Practice Address - Street 1:130 COLE RD
Practice Address - Street 2:
Practice Address - City:DELANSON
Practice Address - State:NY
Practice Address - Zip Code:12053-3120
Practice Address - Country:US
Practice Address - Phone:518-895-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYEX1397863416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01679405Medicaid
NY01679405Medicaid