Provider Demographics
NPI:1679158786
Name:SEGURA EXECUTIVE TRANSPORTATION CORP
Entity Type:Organization
Organization Name:SEGURA EXECUTIVE TRANSPORTATION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BISMAR
Authorized Official - Middle Name:BIENVENIDO
Authorized Official - Last Name:SEGURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-749-9555
Mailing Address - Street 1:8237A 164TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1120
Mailing Address - Country:US
Mailing Address - Phone:718-749-9555
Mailing Address - Fax:718-462-2727
Practice Address - Street 1:8237A 164TH ST STE 2
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1120
Practice Address - Country:US
Practice Address - Phone:718-749-9555
Practice Address - Fax:718-462-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)