Healthcare Provider Details

I. General information

NPI: 1316244148
Provider Name (Legal Business Name): FOUR EIGHTS TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 STATE ST
OTISVILLE NY
10963-2354
US

IV. Provider business mailing address

PO BOX 287
OTISVILLE NY
10963-0287
US

V. Phone/Fax

Practice location:
  • Phone: 845-386-8888
  • Fax: 845-386-3741
Mailing address:
  • Phone: 845-386-8888
  • Fax: 845-386-3741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JASON M BRENNAN
Title or Position: OWNER
Credential:
Phone: 845-386-8888