Provider Demographics
NPI:1740215698
Name:PEEKSKILL COMMUNITY VOLUNTEER AMBULANCE CORP
Entity type:Organization
Organization Name:PEEKSKILL COMMUNITY VOLUNTEER AMBULANCE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-755-0450
Mailing Address - Street 1:PO BOX 5442
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5442
Mailing Address - Country:US
Mailing Address - Phone:914-737-5310
Mailing Address - Fax:
Practice Address - Street 1:1427 MAIN ST
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566
Practice Address - Country:US
Practice Address - Phone:914-737-5310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10136341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PEOA070510OtherEMPIRE BCBS
NY01402400Medicaid
319895OtherMVP
9599745OtherGHI
PEOA070510OtherEMPIRE BCBS