Provider Demographics
NPI:1700066479
Name:NASSAU AMBULANCE
Entity Type:Organization
Organization Name:NASSAU AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:VALENTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-603-2455
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-0787
Mailing Address - Country:US
Mailing Address - Phone:888-603-2455
Mailing Address - Fax:518-391-2601
Practice Address - Street 1:498 MCCLELLAN DR
Practice Address - Street 2:
Practice Address - City:NASSAU
Practice Address - State:NY
Practice Address - Zip Code:12123-3930
Practice Address - Country:US
Practice Address - Phone:888-603-2455
Practice Address - Fax:518-391-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10786341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02966003Medicaid
NYBA1304Medicare PIN