Healthcare Provider Details

I. General information

NPI: 1477053064
Provider Name (Legal Business Name): STATCOM - CITYWIDE MOBILITY AREA RAPID TRANSIT AUTHORITY MC OF NY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 09/12/2025
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 AIRPORT CENTER DR STE 16
NEW WINDSOR NY
12553-4743
US

IV. Provider business mailing address

630 LENOX AVENUE SUITE# 16M
NEW YORK NY
10037
US

V. Phone/Fax

Practice location:
  • Phone: 646-387-2810
  • Fax: 646-403-2561
Mailing address:
  • Phone: 646-387-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code3416S0300X
TaxonomyWater Ambulance
License Number
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateGA
# 9
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNY
# 10
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 11
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateGA

VIII. Authorized Official

Name: MR. DARRYL D TERRY-LOCKLARY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 646-387-2810