Provider Demographics
NPI:1558686600
Name:ABBA LOCAL TRANSPORTATION INC
Entity Type:Organization
Organization Name:ABBA LOCAL TRANSPORTATION INC
Other - Org Name:U.S.AMBULETTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ARKHIPOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-225-3700
Mailing Address - Street 1:1612 NEPTUNE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2830
Mailing Address - Country:US
Mailing Address - Phone:718-946-1000
Mailing Address - Fax:718-444-1582
Practice Address - Street 1:1612 NEPTUNE AVE STE 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2830
Practice Address - Country:US
Practice Address - Phone:718-946-1000
Practice Address - Fax:718-444-1582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB90675343900000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03682051Medicaid