Healthcare Provider Details

I. General information

NPI: 1174076798
Provider Name (Legal Business Name): RIVERTOWN TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 WILLIAMSBURG DR
NEWBURGH NY
12550-3260
US

IV. Provider business mailing address

51 WILLIAMSBURG DR
NEWBURGH NY
12550-3260
US

V. Phone/Fax

Practice location:
  • Phone: 845-563-0150
  • Fax:
Mailing address:
  • Phone: 845-563-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number00075-16
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number00075-16
License Number StateNY

VIII. Authorized Official

Name: MR. RODNEY S TILLMAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 845-563-0150