=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912411463
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOES TAXI RIDE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2017
-----------------------------------------------------
Last Update Date | 11/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1420 MONTAUK HWY
-----------------------------------------------------
City | MASTIC
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11950-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-399-1111
-----------------------------------------------------
Fax | 631-629-4852
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1420 MONTAUK HWY
-----------------------------------------------------
City | MASTIC
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11950-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-399-1111
-----------------------------------------------------
Fax | 631-629-4852
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/SOLE OWNER
-----------------------------------------------------
Name | MOHAMMAD IQBAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 631-569-9474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------