MEDICARE: FIVE BORO MEDICAL TRANSPORTATION

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)	31340	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265698740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE BORO MEDICAL TRANSPORTATION

Provider Business Mailing Address
First Line	:	1231 AVENUE U
Second Line	:	SECOND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4101
Country	:	US
Telephone Number	:	718-382-4949
Fax Number	:

Provider Business Practice Location Address
First Line	:	1231 AVENUE U
Second Line	:	SECOND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4101
Country	:	US
Telephone Number	:	718-382-4949
Fax Number	:	718-382-1783

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEONID ZABARA
Credential	:
Telephone Number	:	718-382-4949

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	08/04/2008

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