Healthcare Provider Details

I. General information

NPI: 1093632754
Provider Name (Legal Business Name): BLUE MOUNTAIN TRANSIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 W BOYLSTON ST STE 204
WORCESTER MA
01606-1167
US

IV. Provider business mailing address

1078 W BOYLSTON ST STE 204
WORCESTER MA
01606-1167
US

V. Phone/Fax

Practice location:
  • Phone: 516-476-7713
  • Fax:
Mailing address:
  • Phone: 516-476-7713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: JERMAINE ELVIN
Title or Position: CO-OWNER
Credential:
Phone: 516-476-7713