Provider Demographics
NPI:1316561285
Name:MDM TRANSPORTATION CORP.
Entity Type:Organization
Organization Name:MDM TRANSPORTATION CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUNIOR
Authorized Official - Middle Name:
Authorized Official - Last Name:LINARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-281-5555
Mailing Address - Street 1:548 THROGGS NECK EXPY STE D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:548 THROGGS NECK EXPY STE D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1717
Practice Address - Country:US
Practice Address - Phone:347-281-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05975764Medicaid