Provider Demographics
NPI:1295291490
Name:PRINCE PROFESSIONAL TRANSPORT, LLC
Entity type:Organization
Organization Name:PRINCE PROFESSIONAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:W
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-730-0756
Mailing Address - Street 1:22 TIMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-1044
Mailing Address - Country:US
Mailing Address - Phone:585-730-0756
Mailing Address - Fax:
Practice Address - Street 1:22 TIMBERWOOD DR
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-1044
Practice Address - Country:US
Practice Address - Phone:585-730-0756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05126898Medicaid