Provider Demographics
NPI:1467440867
Name:CORONA COMMUNITY AMBULANCE CORPS, INC.
Entity type:Organization
Organization Name:CORONA COMMUNITY AMBULANCE CORPS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PERNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-592-7964
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-0519
Mailing Address - Country:US
Mailing Address - Phone:914-366-4004
Mailing Address - Fax:914-366-4111
Practice Address - Street 1:10438 47TH AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2821
Practice Address - Country:US
Practice Address - Phone:718-592-7964
Practice Address - Fax:718-592-1625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7344341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01655150Medicaid
NY1467440867OtherRAILROAD MEDICARE
NY01655150Medicaid