Provider Demographics
NPI:1255872214
Name:PATCHOGUE FIRE DEPT AMBULANCE CO INC
Entity type:Organization
Organization Name:PATCHOGUE FIRE DEPT AMBULANCE CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-872-9084
Mailing Address - Street 1:336 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3010
Mailing Address - Country:US
Mailing Address - Phone:631-475-5490
Mailing Address - Fax:
Practice Address - Street 1:336 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3010
Practice Address - Country:US
Practice Address - Phone:631-475-5490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2024-04-16
Deactivation Date:2023-12-28
Deactivation Code:
Reactivation Date:2024-02-02
Provider Licenses
StateLicense IDTaxonomies
NY325383416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport