Provider Demographics
NPI:1467720821
Name:MENAHEM SIMKHO TRANSPORTATION INC.
Entity Type:Organization
Organization Name:MENAHEM SIMKHO TRANSPORTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMKHO
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUPOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-420-2338
Mailing Address - Street 1:1428 36TH ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3710
Mailing Address - Country:US
Mailing Address - Phone:718-484-8840
Mailing Address - Fax:718-484-8839
Practice Address - Street 1:1428 36TH ST
Practice Address - Street 2:SUITE 225
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3710
Practice Address - Country:US
Practice Address - Phone:718-484-8840
Practice Address - Fax:718-484-8839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB90673343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03121657Medicaid