Healthcare Provider Details

I. General information

NPI: 1639614134
Provider Name (Legal Business Name): ABACO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 10/08/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14748 ROOSEVELT AVE STE L9
FLUSHING NY
11354
US

IV. Provider business mailing address

14748 ROOSEVELT AVE STE L9
FLUSHING NY
11354
US

V. Phone/Fax

Practice location:
  • Phone: 718-312-0375
  • Fax: 212-564-8908
Mailing address:
  • Phone: 718-312-0375
  • Fax: 212-564-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number30693
License Number StateNY

VIII. Authorized Official

Name: DANIEL PARK
Title or Position: PRESIDENT
Credential:
Phone: 718-312-0375