Healthcare Provider Details

I. General information

NPI: 1124570049
Provider Name (Legal Business Name): JFK LUXURY LIMOUSINE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8006 101ST AVE
OZONE PARK NY
11416-1939
US

IV. Provider business mailing address

8006 101ST AVE
OZONE PARK NY
11416-1939
US

V. Phone/Fax

Practice location:
  • Phone: 718-659-5501
  • Fax:
Mailing address:
  • Phone: 718-659-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License NumberB02903
License Number StateNY

VIII. Authorized Official

Name: MR. CARLOS SIMBANA
Title or Position: PRESIDENT
Credential:
Phone: 718-659-5501