Healthcare Provider Details

I. General information

NPI: 1861205072
Provider Name (Legal Business Name): BLUE FALCON BROKERAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 NE 42ND ST
DEERFIELD BEACH FL
33064-3522
US

IV. Provider business mailing address

242 NE 42ND ST
DEERFIELD BEACH FL
33064-3522
US

V. Phone/Fax

Practice location:
  • Phone: 407-722-4911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LUBIN
Title or Position: MANAGER
Credential:
Phone: 407-722-4911