=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225277478
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARLBORO CAR SERVICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2009
-----------------------------------------------------
Last Update Date | 02/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 275 KINGS HWY
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11223-1346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-229-0000
-----------------------------------------------------
Fax | 718-434-2166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2615 CONEY ISLAND AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11223-5501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-229-0000
-----------------------------------------------------
Fax | 718-434-2166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | IGOR ARKHIPOV
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 347-229-0000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number | B00987
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------