Healthcare Provider Details

I. General information

NPI: 1649525494
Provider Name (Legal Business Name): ALTAMONT AVENUE TAXI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 GREENLAWN AVE
SCHENECTADY NY
12306-4316
US

IV. Provider business mailing address

192 GREENLAWN AVE
SCHENECTADY NY
12306-4316
US

V. Phone/Fax

Practice location:
  • Phone: 518-528-4439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number478744154
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number478744154
License Number StateNY

VIII. Authorized Official

Name: MR. MICHAEL ONEIL
Title or Position: OWNER
Credential:
Phone: 518-459-0675