MEDICARE: HAYLEY'S COMET LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	01527471	NY

General Provider Information

NPI Number	:	1003070038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAYLEY'S COMET LLC

Provider Business Mailing Address
First Line	:	1369 BLONDELL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2616
Country	:	US
Telephone Number	:	347-810-1700
Fax Number	:	347-810-1698

Provider Business Practice Location Address
First Line	:	1369 BLONDELL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2616
Country	:	US
Telephone Number	:	347-810-1700
Fax Number	:	347-810-1698

Authorized Official
Title or Position	:	MEMBER
Name	:	MS. CARMEN GOMEZ GOLDBERG
Credential	:
Telephone Number	:	914-225-4004

Provider Enumeration Date	:	07/18/2008
Last Update Date	:	07/18/2008

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