Provider Demographics
NPI:1831273358
Name:NORTHEAST SHUTTLE SERVICE
Entity type:Organization
Organization Name:NORTHEAST SHUTTLE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-235-8100
Mailing Address - Street 1:23 RUSSELL CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-9719
Mailing Address - Country:US
Mailing Address - Phone:518-235-8100
Mailing Address - Fax:518-235-8150
Practice Address - Street 1:23 RUSSELL CT
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-9719
Practice Address - Country:US
Practice Address - Phone:518-235-8100
Practice Address - Fax:518-235-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02360290343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02360290Medicaid