Healthcare Provider Details

I. General information

NPI: 1659757938
Provider Name (Legal Business Name): SLK TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HIGHLAND AVE
SMALLWOOD NY
12778
US

IV. Provider business mailing address

3405 NEPTUNE AVE 1141
BROOKLYN NY
11224-1673
US

V. Phone/Fax

Practice location:
  • Phone: 845-513-4090
  • Fax: 845-513-4091
Mailing address:
  • Phone: 845-513-4090
  • Fax: 845-513-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number39183
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number39183
License Number StateNY

VIII. Authorized Official

Name: YELENA KACHEROVSKY
Title or Position: PRESIDENT
Credential:
Phone: 845-513-4090