Provider Demographics
NPI:1639614134
Name:ABACO INC
Entity Type:Organization
Organization Name:ABACO INC
Other - Org Name:ABACO TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ZAFAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAMITDINOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-312-0375
Mailing Address - Street 1:7318 YELLOWSTONE BLVD
Mailing Address - Street 2:APT D BASEMENT
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4198
Mailing Address - Country:US
Mailing Address - Phone:718-312-0375
Mailing Address - Fax:888-909-7594
Practice Address - Street 1:7318 YELLOWSTONE BLVD
Practice Address - Street 2:APT D BASEMENT
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4198
Practice Address - Country:US
Practice Address - Phone:718-312-0375
Practice Address - Fax:888-909-7594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30693343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04566010Medicaid