Provider Demographics
NPI:1063790327
Name:SUNLIFE AMBULANCE INC.
Entity type:Organization
Organization Name:SUNLIFE AMBULANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MASYUK
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:215-245-8111
Mailing Address - Street 1:2522 STATE RD. BLDG. D UNIT 101
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020
Mailing Address - Country:US
Mailing Address - Phone:215-245-8111
Mailing Address - Fax:215-245-7111
Practice Address - Street 1:2522 STATE RD. BLDG. D UNIT 101
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020
Practice Address - Country:US
Practice Address - Phone:215-245-8111
Practice Address - Fax:215-245-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA110363416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport