Provider Demographics
NPI:1295157998
Name:FAMILY AMBULANCE
Entity type:Organization
Organization Name:FAMILY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MALYUHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-821-0799
Mailing Address - Street 1:27 TOMLINSON RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-4218
Mailing Address - Country:US
Mailing Address - Phone:215-821-0799
Mailing Address - Fax:
Practice Address - Street 1:27 TOMLINSON RD
Practice Address - Street 2:SUITE 107
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-4218
Practice Address - Country:US
Practice Address - Phone:215-821-0799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA130263416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport