Healthcare Provider Details

I. General information

NPI: 1902394315
Provider Name (Legal Business Name): ELIASTAXTIAND TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 CALDER AVE
YORKVILLE NY
13495-1603
US

IV. Provider business mailing address

49 CALDER AVE
YORKVILLE NY
13495-1603
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-1888
  • Fax: 315-507-4943
Mailing address:
  • Phone: 315-737-1888
  • Fax: 315-507-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number577420528
License Number StateNY

VIII. Authorized Official

Name: ALI ELZABER
Title or Position: OWNER
Credential:
Phone: 315-737-1888