Provider Demographics
NPI:1942351341
Name:LEEWAY TRANSPORTATION INC
Entity Type:Organization
Organization Name:LEEWAY TRANSPORTATION INC
Other - Org Name:CHOICE MEDICAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-207-2222
Mailing Address - Street 1:45 PERRI CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-2660
Mailing Address - Country:US
Mailing Address - Phone:631-924-7667
Mailing Address - Fax:
Practice Address - Street 1:45 PERRI CIR
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-2660
Practice Address - Country:US
Practice Address - Phone:631-924-7667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35567343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02330436Medicaid