Provider Demographics
NPI:1124459268
Name:SAFA AMBULETTE LLC.
Entity type:Organization
Organization Name:SAFA AMBULETTE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDELAZIM
Authorized Official - Middle Name:BALLA
Authorized Official - Last Name:ABDALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-358-0105
Mailing Address - Street 1:228 BAY 43RD ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6708
Mailing Address - Country:US
Mailing Address - Phone:646-358-0105
Mailing Address - Fax:866-670-4824
Practice Address - Street 1:228 BAY 43RD ST
Practice Address - Street 2:APT. 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6708
Practice Address - Country:US
Practice Address - Phone:646-358-0105
Practice Address - Fax:866-670-4824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02685321Medicaid