Provider Demographics
NPI:1295965606
Name:LAKEVILLE AMBULETTE TRANSPORTATION LLC
Entity type:Organization
Organization Name:LAKEVILLE AMBULETTE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-289-2354
Mailing Address - Street 1:27111 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1436
Mailing Address - Country:US
Mailing Address - Phone:718-289-2100
Mailing Address - Fax:718-289-2323
Practice Address - Street 1:27111 76TH AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1436
Practice Address - Country:US
Practice Address - Phone:718-289-2100
Practice Address - Fax:718-289-2323
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKER JEWISH INSTITUTE FOR HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02975313Medicaid