Healthcare Provider Details

I. General information

NPI: 1336808773
Provider Name (Legal Business Name): 305 MEDTRANS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12010 15TH AVE STE 6
COLLEGE POINT NY
11356-1645
US

IV. Provider business mailing address

12010 15TH AVE STE 6
COLLEGE POINT NY
11356-1645
US

V. Phone/Fax

Practice location:
  • Phone: 347-697-4660
  • Fax: 516-472-0812
Mailing address:
  • Phone: 347-697-4660
  • Fax: 516-472-0812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAN C ZABALA
Title or Position: PRESIDENT
Credential:
Phone: 347-697-4660