Healthcare Provider Details

I. General information

NPI: 1932721172
Provider Name (Legal Business Name): KNP LUXURY LIMOUSINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 HAWTHORNE TER
MOUNT VERNON NY
10552-2426
US

IV. Provider business mailing address

374 HAWTHORNE TER
MOUNT VERNON NY
10552-2426
US

V. Phone/Fax

Practice location:
  • Phone: 917-681-6971
  • Fax: 914-664-7918
Mailing address:
  • Phone: 917-681-6971
  • Fax: 914-664-7918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: PETER LUANGISA
Title or Position: OWNER
Credential:
Phone: 917-681-6971