Provider Demographics
NPI:1477053064
Name:STATCOM - CITYWIDE MOBILITY AREA RAPID TRANSIT AUTHORITY MC OF NY
Entity Type:Organization
Organization Name:STATCOM - CITYWIDE MOBILITY AREA RAPID TRANSIT AUTHORITY MC OF NY
Other - Org Name:STATCOM - CITYWIDE MARTA MISSION CRITICAL OF NY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TERRY-LOCKLARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-387-2810
Mailing Address - Street 1:630 LENOX AVENUE
Mailing Address - Street 2:SUITE# 16M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037
Mailing Address - Country:US
Mailing Address - Phone:646-387-2810
Mailing Address - Fax:
Practice Address - Street 1:33 AIRPORT CENTER DR STE 16
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-4743
Practice Address - Country:US
Practice Address - Phone:646-387-2810
Practice Address - Fax:646-403-2561
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATCOM - CITYWIDE MOBILITY AREA RAPID TRANSIT AUTHORITY MC CO.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273R00000X, 332BX2000X, 343900000X
GA341600000X, 3416A0800X, 3416L0300X, 3416S0300X, 343800000X, 343900000X, 347E00000X
NY343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No273R00000XHospital UnitsPsychiatric Unit
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No341600000XTransportation ServicesAmbulance
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416S0300XTransportation ServicesAmbulanceWater Transport
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker