Provider Demographics
NPI:1083260103
Name:GREENLIGHT TRANSPORTATION SERVICE LLC
Entity Type:Organization
Organization Name:GREENLIGHT TRANSPORTATION SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:SHAZAM
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-480-6875
Mailing Address - Street 1:10120 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1702
Mailing Address - Country:US
Mailing Address - Phone:718-480-6875
Mailing Address - Fax:718-480-1267
Practice Address - Street 1:10120 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1702
Practice Address - Country:US
Practice Address - Phone:718-480-6875
Practice Address - Fax:718-480-1267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)