Provider Demographics
NPI:1538702741
Name:SIMBANA, ENRIQUE R I (CITYLINE CAR SERVICE)
Entity Type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:R
Last Name:SIMBANA
Suffix:I
Gender:M
Credentials:CITYLINE CAR SERVICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8006 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-1939
Mailing Address - Country:US
Mailing Address - Phone:718-848-5555
Mailing Address - Fax:
Practice Address - Street 1:8006 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-1939
Practice Address - Country:US
Practice Address - Phone:718-848-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB01553344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05683821Medicaid