Provider Demographics
NPI:1851638670
Name:MAYSHAMAR AMBULETTE SERVICES
Entity Type:Organization
Organization Name:MAYSHAMAR AMBULETTE SERVICES
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MAYLENE
Authorized Official - Middle Name:SYDNEE
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER/OPERATOR/PROVI
Authorized Official - Phone:347-733-9569
Mailing Address - Street 1:33 OLIVER PLACE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:347-733-9569
Mailing Address - Fax:347-733-9569
Practice Address - Street 1:33 OLIVER PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3221
Practice Address - Country:US
Practice Address - Phone:347-733-9569
Practice Address - Fax:347-733-9569
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:122345699
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY994468812Medicare PIN