Provider Demographics
NPI:1831362557
Name:KINGSTON KABS, INC.
Entity type:Organization
Organization Name:KINGSTON KABS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:INGERID
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINTRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-922-2640
Mailing Address - Street 1:PO BOX 2622
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402-2622
Mailing Address - Country:US
Mailing Address - Phone:516-922-2640
Mailing Address - Fax:516-922-3724
Practice Address - Street 1:440 ROUTE 28
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-7446
Practice Address - Country:US
Practice Address - Phone:516-922-2640
Practice Address - Fax:516-922-3724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01545000Medicaid