Provider Demographics
NPI:1952773384
Name:PERSIST CORPORATION
Entity Type:Organization
Organization Name:PERSIST CORPORATION
Other - Org Name:N/A
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-832-2995
Mailing Address - Street 1:1939 GRAND CONCOURSE
Mailing Address - Street 2:APT. 7 I
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4917
Mailing Address - Country:US
Mailing Address - Phone:718-466-0040
Mailing Address - Fax:917-801-2997
Practice Address - Street 1:1939 GRAND CONCOURSE
Practice Address - Street 2:APT. 7 I
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4917
Practice Address - Country:US
Practice Address - Phone:718-466-0040
Practice Address - Fax:917-801-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========Medicaid