Healthcare Provider Details

I. General information

NPI: 1750180220
Provider Name (Legal Business Name): COREY DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 708
BRONX NY
10451-0708
US

IV. Provider business mailing address

PO BOX 708
BRONX NY
10451-0708
US

V. Phone/Fax

Practice location:
  • Phone: 718-440-0019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number5579486
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: