Provider Demographics
NPI:1023489986
Name:UPSTATE AMBULETTE
Entity type:Organization
Organization Name:UPSTATE AMBULETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1845-222-4470
Mailing Address - Street 1:51 FOREST RD
Mailing Address - Street 2:316-201
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-2948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:51 FOREST RD
Practice Address - Street 2:316-201
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-2948
Practice Address - Country:US
Practice Address - Phone:184-522-2447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)