Provider Demographics
NPI:1205372133
Name:AVERY'S TAXI LLC
Entity type:Organization
Organization Name:AVERY'S TAXI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-860-2151
Mailing Address - Street 1:85 WINEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4719
Mailing Address - Country:US
Mailing Address - Phone:518-321-6195
Mailing Address - Fax:
Practice Address - Street 1:85 WINEBERRY LN
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-4719
Practice Address - Country:US
Practice Address - Phone:518-321-6195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03316947Medicaid