Provider Demographics
NPI:1124570049
Name:JFK LUXURY LIMOUSINE INC.
Entity Type:Organization
Organization Name:JFK LUXURY LIMOUSINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMBANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-659-5501
Mailing Address - Street 1:8006 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-1939
Mailing Address - Country:US
Mailing Address - Phone:718-659-5501
Mailing Address - Fax:
Practice Address - Street 1:8006 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-1939
Practice Address - Country:US
Practice Address - Phone:718-659-5501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB02903344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04493101Medicaid