Provider Demographics
NPI:1699843961
Name:PRIVATE ESCORT SERVICE INC.
Entity Type:Organization
Organization Name:PRIVATE ESCORT SERVICE INC.
Other - Org Name:BROOKLYN EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-629-6520
Mailing Address - Street 1:1261 RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1415
Mailing Address - Country:US
Mailing Address - Phone:718-629-6520
Mailing Address - Fax:718-629-6524
Practice Address - Street 1:1261 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-1415
Practice Address - Country:US
Practice Address - Phone:718-629-6520
Practice Address - Fax:718-629-6524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29953343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00813061Medicaid