Provider Demographics
NPI:1881655264
Name:PORT JERVIS VOLUNTEER AMBULANCE CORPS INC
Entity Type:Organization
Organization Name:PORT JERVIS VOLUNTEER AMBULANCE CORPS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-856-3033
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-0133
Mailing Address - Country:US
Mailing Address - Phone:845-856-3033
Mailing Address - Fax:845-858-2312
Practice Address - Street 1:29 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2011
Practice Address - Country:US
Practice Address - Phone:845-856-3033
Practice Address - Fax:845-858-2312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104323416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01798874Medicaid
NY590012837OtherMEDICARE RAILROAD
NY01798874Medicaid