Provider Demographics
NPI:1417498452
Name:WWW WASHME TV
Entity Type:Organization
Organization Name:WWW WASHME TV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:B
Authorized Official - Last Name:FLORESTAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-308-5628
Mailing Address - Street 1:1 BEATTIE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4047
Mailing Address - Country:US
Mailing Address - Phone:718-308-5628
Mailing Address - Fax:
Practice Address - Street 1:1 BEATTIE AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4047
Practice Address - Country:US
Practice Address - Phone:718-308-5628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243877095343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)