Provider Demographics
NPI:1386195022
Name:MASTIC TRANSPORTATION INC.
Entity Type:Organization
Organization Name:MASTIC TRANSPORTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:AVA
Authorized Official - Middle Name:LEILA
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-295-0738
Mailing Address - Street 1:82 SURREY CIR STE D
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-2549
Mailing Address - Country:US
Mailing Address - Phone:631-399-1111
Mailing Address - Fax:631-629-4852
Practice Address - Street 1:82 SURREY CIR STE D
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2549
Practice Address - Country:US
Practice Address - Phone:631-399-1111
Practice Address - Fax:631-629-4852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04184290Medicaid