Healthcare Provider Details

I. General information

NPI: 1154755916
Provider Name (Legal Business Name): HAWK CAR AND LIMO SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 MIDLAND AVE GROUND FLOOR
STATEN ISLAND NY
10306-5928
US

IV. Provider business mailing address

591 MIDLAND AVE GROUND FLOOR
STATEN ISLAND NY
10306-5928
US

V. Phone/Fax

Practice location:
  • Phone: 718-650-3535
  • Fax: 718-907-7933
Mailing address:
  • Phone: 718-650-3535
  • Fax: 718-907-7933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: IGOR GIRKHOVSKIY
Title or Position: PRESIDENT
Credential:
Phone: 718-650-3535