Provider Demographics
NPI:1831574086
Name:MASSIVE TRANSPORTATION INC
Entity type:Organization
Organization Name:MASSIVE TRANSPORTATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DURVIJAI
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-253-6590
Mailing Address - Street 1:145 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1347
Mailing Address - Country:US
Mailing Address - Phone:914-664-3124
Mailing Address - Fax:914-665-3130
Practice Address - Street 1:145 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1347
Practice Address - Country:US
Practice Address - Phone:914-664-3124
Practice Address - Fax:914-665-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04042297Medicaid