1578770764 NPI number — SAFA AMBULETTE LLC

Table of content: (NPI 1578770764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578770764 NPI number — SAFA AMBULETTE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAFA AMBULETTE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578770764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2651 CROPSEY AVE
Provider Second Line Business Mailing Address:
FIRST FLOOR
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11214-6712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-358-0105
Provider Business Mailing Address Fax Number:
347-312-7160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2651 CROPSEY AVE
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11214-6712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-358-0105
Provider Business Practice Location Address Fax Number:
347-312-7160
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ABDALLA
Authorized Official First Name:
ABDELAZIM
Authorized Official Middle Name:
BALLA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
646-358-0105

Provider Taxonomy Codes

  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02685321 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com