=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023542859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROADRUNNER TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2017
-----------------------------------------------------
Last Update Date | 04/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2411 8TH AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10027-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-710-8302
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2411 8TH AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10026-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-710-8302
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANEGER
-----------------------------------------------------
Name | CARLOS NAVARRO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-710-8302
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number | 295153278
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------