Provider Demographics
NPI:1235462441
Name:MAGIC MISSILE TRANSPORTATION
Entity Type:Organization
Organization Name:MAGIC MISSILE TRANSPORTATION
Other - Org Name:MM TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:OSYATINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-587-1386
Mailing Address - Street 1:4354 N 82ND STREET
Mailing Address - Street 2:STE201
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251
Mailing Address - Country:US
Mailing Address - Phone:480-381-4262
Mailing Address - Fax:480-393-7399
Practice Address - Street 1:4354 N 82ND ST
Practice Address - Street 2:STE201
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-2738
Practice Address - Country:US
Practice Address - Phone:480-381-4262
Practice Address - Fax:480-393-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265580123343900000X, 344600000X, 347B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No347B00000XTransportation ServicesBus