=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073991808
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDCAB
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2015
-----------------------------------------------------
Last Update Date | 05/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 285 EVANS ST APT.1
-----------------------------------------------------
City | WILIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-637-9044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 285 EVANS ST APT.1
-----------------------------------------------------
City | WILIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-637-9044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SURJIT SOOD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-637-9044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number | 18074LV
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------