=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124620372
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUEENSBURY TAXI CAB AND LIMOUSINE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2020
-----------------------------------------------------
Last Update Date | 11/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 SOUTH ST
-----------------------------------------------------
City | GLENS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12801-4323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-743-1234
-----------------------------------------------------
Fax | 518-792-2000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 60 SOUTH ST
-----------------------------------------------------
City | GLENS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12801-4323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-743-1234
-----------------------------------------------------
Fax | 518-792-2000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MRS. MELANIE COHEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 518-470-2533
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------