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General NPI Number Information
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NPI Number | 1053950915
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Entity Type | Organization
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Legal Business Name | LESTAT CORP
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Dates
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Enumeration Date | 12/24/2019
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 651 RIVERSIDE AVE APT C47
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City | LYNDHURST
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State | NJ
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Zip | 07071-3069
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Country | US
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Telephone | 201-335-0134
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 825406
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City | PHILADELPHIA
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State | PA
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Zip | 19182-5406
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Country | US
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Telephone | 201-335-0134
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NAZAR BURAK
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Credential |
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Telephone | 201-747-0141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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