Provider Demographics
NPI:1669612453
Name:NORTHEAST AMBULETTE INC
Entity type:Organization
Organization Name:NORTHEAST AMBULETTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / COO / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCPHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-656-3231
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:NORTHEAST AMBULETTE INC
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-0578
Mailing Address - Country:US
Mailing Address - Phone:631-656-3231
Mailing Address - Fax:631-656-3208
Practice Address - Street 1:335 KNICKERBOCKER AVE
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-3118
Practice Address - Country:US
Practice Address - Phone:631-656-3231
Practice Address - Fax:631-656-3208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02877498343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02877498Medicaid