Provider Demographics
NPI:1275762502
Name:TEJET EXPRESS TRANSPORTATION
Entity Type:Organization
Organization Name:TEJET EXPRESS TRANSPORTATION
Other - Org Name:TEJET TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PESOCHINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-252-7272
Mailing Address - Street 1:1227 AVENUE U
Mailing Address - Street 2:2 ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4101
Mailing Address - Country:US
Mailing Address - Phone:718-252-7272
Mailing Address - Fax:718-252-7272
Practice Address - Street 1:1227 AVENUE U
Practice Address - Street 2:2 ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4101
Practice Address - Country:US
Practice Address - Phone:718-252-7272
Practice Address - Fax:718-252-7272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03111319OtherMEDICAID