=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588039366
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GO A2B TRANSPORTATION INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2015
-----------------------------------------------------
Last Update Date | 12/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 STORM DR
-----------------------------------------------------
City | POUGHQUAG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12570-5704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-264-5350
-----------------------------------------------------
Fax | 845-868-3179
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 STORM DR
-----------------------------------------------------
City | POUGHQUAG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12570-5704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-264-5350
-----------------------------------------------------
Fax | 845-868-3179
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MICHAEL EDWARD ANGLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-264-5350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 630245639
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------