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General NPI Number Information
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NPI Number | 1588707079
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Entity Type | Organization
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Legal Business Name | EASTERN LONG ISLAND TRANSPORTATION ENT.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 269 MIDDLE ISLAND RD
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City | MEDFORD
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State | NY
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Zip | 11763-1507
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Country | US
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Telephone | 631-732-6400
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Fax | 631-732-6416
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Provider Business Mailing Address
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Address Line | 46 PENTMOOR DR
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City | MASTIC
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State | NY
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Zip | 11950-1606
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Country | US
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Telephone | 631-281-0849
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TIMOTHY J RYAN
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Credential |
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Telephone | 631-732-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | NY
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