Provider Demographics
NPI:1760550214
Name:MEDICAB OF ROCHESTER INC
Entity Type:Organization
Organization Name:MEDICAB OF ROCHESTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECYTREAS
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RADDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-342-7150
Mailing Address - Street 1:1449 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-1716
Mailing Address - Country:US
Mailing Address - Phone:585-342-7150
Mailing Address - Fax:585-342-0408
Practice Address - Street 1:1449 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-1716
Practice Address - Country:US
Practice Address - Phone:585-342-7150
Practice Address - Fax:585-342-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCASE28438343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00321499Medicaid