Provider Demographics
NPI:1225636665
Name:CJ MEDI CAB SERVICE LLC
Entity Type:Organization
Organization Name:CJ MEDI CAB SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SATCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:518-930-1333
Mailing Address - Street 1:4 WREN ST # 1
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-5006
Mailing Address - Country:US
Mailing Address - Phone:518-705-2355
Mailing Address - Fax:
Practice Address - Street 1:4 WREN ST # 1
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-5006
Practice Address - Country:US
Practice Address - Phone:518-930-1333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05283376Medicaid