Provider Demographics
NPI:1982856845
Name:VIRGO AMBULETTE INC
Entity Type:Organization
Organization Name:VIRGO AMBULETTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ALIX
Authorized Official - Last Name:PORTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-677-0317
Mailing Address - Street 1:13 KALMIA LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 KALMIA LN VALLEY SREAM NY 11581
Practice Address - Street 2:4222 AVE I
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11581
Practice Address - Country:US
Practice Address - Phone:718-677-0317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30801343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01089385Medicaid