Provider Demographics
NPI:1013918564
Name:PORT JERVIS VOLUNTEER AMBCORPS
Entity Type:Organization
Organization Name:PORT JERVIS VOLUNTEER AMBCORPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:A
Authorized Official - Last Name:AUMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-856-7051
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-0004
Mailing Address - Country:US
Mailing Address - Phone:845-856-3033
Mailing Address - Fax:
Practice Address - Street 1:CHURCH ST. & BARCELOW ST.
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12271
Practice Address - Country:US
Practice Address - Phone:845-856-3033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport