Provider Demographics
NPI:1689049322
Name:CREATE TRANSPORT LLC
Entity Type:Organization
Organization Name:CREATE TRANSPORT LLC
Other - Org Name:CREATE TRANSPORT LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:COMMERCIAL LICENSE
Authorized Official - Phone:315-800-2178
Mailing Address - Street 1:132 MEREDITH AVE
Mailing Address - Street 2:
Mailing Address - City:NEDROW
Mailing Address - State:NY
Mailing Address - Zip Code:13120-1119
Mailing Address - Country:US
Mailing Address - Phone:315-800-2178
Mailing Address - Fax:
Practice Address - Street 1:10 E 40TH ST FL 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0201
Practice Address - Country:US
Practice Address - Phone:315-800-2178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY845775075343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)