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General NPI Number Information
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NPI Number | 1275947442
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Entity Type | Organization
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Legal Business Name | CALIFORNIA MEDTRANS NETWORK IPA LLC
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 2950 EXPRESS DR S
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City | ISLANDIA
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State | NY
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Zip | 11749-1400
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Country | US
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Telephone | 631-389-2098
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Fax |
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Provider Business Mailing Address
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Address Line | 992 S 2ND ST
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City | RONKONKOMA
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State | NY
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Zip | 11779-7204
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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 | CEO
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Name | ANDREW WINAKOR
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Credential |
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Telephone | 516-807-9324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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