Healthcare Provider Details

I. General information

NPI: 1477955169
Provider Name (Legal Business Name): DIANE CAR SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7318 YELLOWSTONE BLVD
FOREST HILLS NY
11375-4198
US

IV. Provider business mailing address

7318 YELLOWSTONE BLVD
FOREST HILLS NY
11375-4198
US

V. Phone/Fax

Practice location:
  • Phone: 718-544-4444
  • Fax: 718-544-4424
Mailing address:
  • Phone: 718-544-4444
  • Fax: 718-544-4424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberB02707
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License NumberB02707
License Number StateNY

VIII. Authorized Official

Name: ARKADY ABAYEV
Title or Position: PRESIDENT
Credential:
Phone: 718-544-4444