Healthcare Provider Details

I. General information

NPI: 1396941407
Provider Name (Legal Business Name): SUBURBAN TRANSPORTATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6327 E MOLLOY RD
EAST SYRACUSE NY
13057-1023
US

IV. Provider business mailing address

6327 E MOLLOY RD
EAST SYRACUSE NY
13057-1023
US

V. Phone/Fax

Practice location:
  • Phone: 315-437-0058
  • Fax: 315-437-5267
Mailing address:
  • Phone: 315-437-0058
  • Fax: 315-437-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MICHAEL F. ILACQUA
Title or Position: PRESIDENT
Credential:
Phone: 315-437-0058