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General NPI Number Information
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NPI Number | 1104280643
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Entity Type | Organization
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Legal Business Name | BCL NETWORK
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 3346 55TH ST
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City | WOODSIDE
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State | NY
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Zip | 11377-1907
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Country | US
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Telephone | 718-424-7077
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Fax | 718-565-2285
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Provider Business Mailing Address
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Address Line | 3346 55TH ST
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City | WOODSIDE
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State | NY
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Zip | 11377-1907
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | EUGENE KLEBANOV
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Credential |
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Telephone | 718-424-7077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number | B02200
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License Number State | NY
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