MEDICARE: AWOSELY JACOB

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)

General Provider Information

NPI Number	:	1003504325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AWOSELY JACOB

Provider Business Mailing Address
First Line	:	2041 ELK DR
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3613
Country	:	US
Telephone Number	:	929-338-2412
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 ELK DR
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3613
Country	:	US
Telephone Number	:	929-338-2412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2023
Last Update Date	:	04/25/2023

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Directions to “ AWOSELY JACOB ” Practice Location

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