MEDICARE: URBAN LUXURY INC.

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	344600000X	Taxi	B03025	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B03025	OTHER	NY	TLC LICENSE #

General Provider Information

NPI Number	:	1558899260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URBAN LUXURY INC.

Provider Business Mailing Address
First Line	:	9302 75TH STREET
Second Line	:	1
City	:	WOODHAVEN
State	:	NY
Zip	:	11421
Country	:	US
Telephone Number	:	718-503-1155
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 IRVING AVE STE 2
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-5302
Country	:	US
Telephone Number	:	718-200-2022
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOEL H PENA
Credential	:
Telephone Number	:	718-503-1155

Provider Enumeration Date	:	05/24/2017
Last Update Date	:	07/21/2022

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