Provider Demographics
NPI:1104383900
Name:SKY TRANSPORTATION LLC
Entity Type:Organization
Organization Name:SKY TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GENOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-518-8726
Mailing Address - Street 1:705 N MOUNTAIN RD STE E103
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-1426
Mailing Address - Country:US
Mailing Address - Phone:917-518-8726
Mailing Address - Fax:
Practice Address - Street 1:705 N MOUNTAIN RD STE E103
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-1426
Practice Address - Country:US
Practice Address - Phone:917-518-8726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTMCD008045652Medicaid