Provider Demographics
NPI:1124474077
Name:MEDTRANS BLACK CAR SERVICE CORP
Entity type:Organization
Organization Name:MEDTRANS BLACK CAR SERVICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRECTARY
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIDOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-442-3963
Mailing Address - Street 1:56-19 METROPOLITAN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11385
Mailing Address - Country:US
Mailing Address - Phone:347-704-6919
Mailing Address - Fax:347-704-6920
Practice Address - Street 1:5619 METROPOLITAN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1958
Practice Address - Country:US
Practice Address - Phone:347-704-1619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB02943343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)