Provider Demographics
NPI:1851517627
Name:GREAT AMBULETTE SVC INC
Entity Type:Organization
Organization Name:GREAT AMBULETTE SVC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHUBRAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-449-2600
Mailing Address - Street 1:1614 NEPTUNE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2718
Mailing Address - Country:US
Mailing Address - Phone:718-449-2600
Mailing Address - Fax:718-449-2646
Practice Address - Street 1:1614 NEPTUNE AVE FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2718
Practice Address - Country:US
Practice Address - Phone:718-449-2600
Practice Address - Fax:718-449-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB90640343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02871185Medicaid
NY02006839Medicaid