Provider Demographics
NPI:1588184519
Name:COLLEGETOWN CAB INC
Entity Type:Organization
Organization Name:COLLEGETOWN CAB INC
Other - Org Name:ACCESS MEDTRANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:H
Authorized Official - Last Name:KRIEGSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-858-2135
Mailing Address - Street 1:618 ELMIRA RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-8745
Mailing Address - Country:US
Mailing Address - Phone:203-858-2135
Mailing Address - Fax:607-697-0489
Practice Address - Street 1:704 W BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3300
Practice Address - Country:US
Practice Address - Phone:203-858-2135
Practice Address - Fax:607-697-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03348318Medicaid