Provider Demographics
NPI:1336808773
Name:305 MEDTRANS CORP
Entity Type:Organization
Organization Name:305 MEDTRANS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ZABALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-697-4660
Mailing Address - Street 1:12010 15TH AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1645
Mailing Address - Country:US
Mailing Address - Phone:347-697-4660
Mailing Address - Fax:516-472-0812
Practice Address - Street 1:12010 15TH AVE STE 6
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-1645
Practice Address - Country:US
Practice Address - Phone:347-697-4660
Practice Address - Fax:516-472-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
No342000000XTransportation ServicesTransportation Network Company
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06435276Medicaid