Healthcare Provider Details

I. General information

NPI: 1013667302
Provider Name (Legal Business Name): KIDAULT KAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 WEST ST UNIT 211C
BROOKLYN NY
11222
US

IV. Provider business mailing address

42 WEST ST UNIT 211C
BROOKLYN NY
11222
US

V. Phone/Fax

Practice location:
  • Phone: 347-380-6266
  • Fax:
Mailing address:
  • Phone: 347-263-4664
  • 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 Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MISS ENITAN SHEPHERD
Title or Position: CEO
Credential:
Phone: 347-263-4664