Provider Demographics
NPI:1932295631
Name:ENERGY AMBULETTE
Entity Type:Organization
Organization Name:ENERGY AMBULETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTORANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-632-2113
Mailing Address - Street 1:350 MOTOR PKWY
Mailing Address - Street 2:SUITE 404
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-5101
Mailing Address - Country:US
Mailing Address - Phone:800-632-2113
Mailing Address - Fax:845-897-1090
Practice Address - Street 1:90 13TH AVE
Practice Address - Street 2:UNIT 4
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-6818
Practice Address - Country:US
Practice Address - Phone:800-632-2113
Practice Address - Fax:845-897-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDOT 36043343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02574867Medicaid