Provider Demographics
NPI:1568004208
Name:MANORVILLE COMMUNITY AMBULANCE INC
Entity type:Organization
Organization Name:MANORVILLE COMMUNITY AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPORUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-278-2140
Mailing Address - Street 1:184 SOUH STREET
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949
Mailing Address - Country:US
Mailing Address - Phone:631-278-2140
Mailing Address - Fax:
Practice Address - Street 1:184 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-3051
Practice Address - Country:US
Practice Address - Phone:631-278-2140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport