Healthcare Provider Details

I. General information

NPI: 1912463647
Provider Name (Legal Business Name): MIKE'S VIP TRANSPORTATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5147 69TH ST STE 2
WOODSIDE NY
11377-7515
US

IV. Provider business mailing address

5147 69TH ST STE 2
WOODSIDE NY
11377-7515
US

V. Phone/Fax

Practice location:
  • Phone: 718-699-4322
  • Fax: 718-699-1799
Mailing address:
  • Phone: 718-699-4322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ANTHONY M BARRERA
Title or Position: PRESIDENT
Credential:
Phone: 718-699-4322