Healthcare Provider Details

I. General information

NPI: 1396657839
Provider Name (Legal Business Name): AGING HEARTS TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 MARTIN PL
VALLEY STREAM NY
11580-1349
US

IV. Provider business mailing address

1061 MARTIN PL
VALLEY STREAM NY
11580-1349
US

V. Phone/Fax

Practice location:
  • Phone: 917-553-5774
  • Fax:
Mailing address:
  • Phone: 917-553-5774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: TERELL MATTHEWS
Title or Position: OWNER
Credential:
Phone: 917-553-5774