Healthcare Provider Details

I. General information

NPI: 1568094100
Provider Name (Legal Business Name): GEWESEN TRANSPORTATION CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 VARICK ST
NEW YORK NY
10014-4604
US

IV. Provider business mailing address

175 VARICK ST
NEW YORK NY
10014-4604
US

V. Phone/Fax

Practice location:
  • Phone: 646-970-3939
  • Fax:
Mailing address:
  • Phone: 646-970-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MAXIMINIO DE JESUS
Title or Position: PRESIDENT
Credential:
Phone: 646-970-3939