Healthcare Provider Details

I. General information

NPI: 1295391514
Provider Name (Legal Business Name): ALLIED BLACK CAR SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 3RD AVE # G8
BRONX NY
10455-4066
US

IV. Provider business mailing address

2825 3RD AVE # G8
BRONX NY
10455-4066
US

V. Phone/Fax

Practice location:
  • Phone: 929-594-7566
  • Fax: 929-999-0594
Mailing address:
  • Phone: 929-594-7566
  • Fax: 929-999-0594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LUIS ONIEL RODRIGUEZ TORRES
Title or Position: ADMINISTRATIVE MANEGER
Credential:
Phone: 929-594-7566