Healthcare Provider Details

I. General information

NPI: 1285461509
Provider Name (Legal Business Name): 172 CSI CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 BLOOMFIELD AVE
BLOOMFIELD NJ
07003-3302
US

IV. Provider business mailing address

570 BLOOMFIELD AVE
BLOOMFIELD NJ
07003-3302
US

V. Phone/Fax

Practice location:
  • Phone: 973-390-2889
  • Fax: 973-743-6036
Mailing address:
  • Phone: 973-390-2889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. KOSMAS G BESSAS
Title or Position: OWNER MANAGER
Credential:
Phone: 973-390-2889