Healthcare Provider Details

I. General information

NPI: 1629632104
Provider Name (Legal Business Name): WOW TRANSPORT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E 23RD ST
HUNTINGTON STATION NY
11746-3254
US

IV. Provider business mailing address

17 E 23RD ST
HUNTINGTON STATION NY
11746-3254
US

V. Phone/Fax

Practice location:
  • Phone: 631-896-0286
  • Fax:
Mailing address:
  • Phone: 631-896-0286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEPHANE DON TORCHON
Title or Position: CEO
Credential:
Phone: 631-896-0286