Provider Demographics
NPI:1932303153
Name:YAD EZRAH INC
Entity Type:Organization
Organization Name:YAD EZRAH INC
Other - Org Name:MEDWAY TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAZER
Authorized Official - Middle Name:
Authorized Official - Last Name:DANCZIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-678-3600
Mailing Address - Street 1:749 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1902
Mailing Address - Country:US
Mailing Address - Phone:845-678-3600
Mailing Address - Fax:845-678-3601
Practice Address - Street 1:749 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1902
Practice Address - Country:US
Practice Address - Phone:845-678-3600
Practice Address - Fax:845-678-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY47935-LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02086717Medicaid