=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063614725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JR CAR SERVICE TLC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 87 VERDI ST
-----------------------------------------------------
City | FARMINGDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11735-6319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-756-5551
-----------------------------------------------------
Fax | 631-756-0898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3494
-----------------------------------------------------
City | FARMINGDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11735-0694
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-756-5551
-----------------------------------------------------
Fax | 631-756-0898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GIOVANNI RECINE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-697-8265
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------