Provider Demographics
NPI:1003088212
Name:MEGA LINE INC
Entity Type:Organization
Organization Name:MEGA LINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFI
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVRIELOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-639-0200
Mailing Address - Street 1:6129 WOODHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2739
Mailing Address - Country:US
Mailing Address - Phone:718-639-0200
Mailing Address - Fax:718-507-1617
Practice Address - Street 1:6129 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2739
Practice Address - Country:US
Practice Address - Phone:718-639-0200
Practice Address - Fax:718-507-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB90648341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02948263Medicaid