Provider Demographics
NPI:1053643353
Name:SENIOR RIDE TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:SENIOR RIDE TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:VATCH
Authorized Official - Suffix:
Authorized Official - Credentials:MPA,CCEMTP
Authorized Official - Phone:718-430-9700
Mailing Address - Street 1:855 BRUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1808
Mailing Address - Country:US
Mailing Address - Phone:718-430-9700
Mailing Address - Fax:718-430-1528
Practice Address - Street 1:855 BRUSH AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1808
Practice Address - Country:US
Practice Address - Phone:718-430-9700
Practice Address - Fax:718-430-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB90681343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03176249Medicaid