Provider Demographics
NPI:1447580048
Name:MOTTYS CAR SERVICE
Entity Type:Organization
Organization Name:MOTTYS CAR SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-783-3401
Mailing Address - Street 1:48 BAKERTOWN RD UNIT 212
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-8430
Mailing Address - Country:US
Mailing Address - Phone:845-783-3401
Mailing Address - Fax:845-230-3298
Practice Address - Street 1:48 BAKERTOWN RD UNIT 212
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-8430
Practice Address - Country:US
Practice Address - Phone:845-783-3401
Practice Address - Fax:845-230-3298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2011-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYACFBMedicaid