Provider Demographics
NPI:1699758755
Name:CORTLANDT COMMUNITY VOLUNTEER AMBULANCE CORPS INC
Entity type:Organization
Organization Name:CORTLANDT COMMUNITY VOLUNTEER AMBULANCE CORPS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRST LIEUTENANT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-739-0881
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:315-635-1789
Mailing Address - Fax:315-635-3289
Practice Address - Street 1:6 KINGS FERRY RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548-1406
Practice Address - Country:US
Practice Address - Phone:914-739-0881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09586341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02065121Medicaid
351023OtherMVP
3200227OtherGHI
590014042OtherPALMETTO GBA-RAILROAD
NY02065121Medicaid