Healthcare Provider Details

I. General information

NPI: 1184409302
Provider Name (Legal Business Name): APPLE CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11274 BEDELL ST
JAMAICA NY
11433-3808
US

IV. Provider business mailing address

11274 BEDELL ST
JAMAICA NY
11433-3808
US

V. Phone/Fax

Practice location:
  • Phone: 929-789-3005
  • Fax:
Mailing address:
  • Phone: 929-789-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. CALVIN RICE
Title or Position: OWNER
Credential:
Phone: 929-789-3005