=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912608472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 2 MARIES TRANSPORTATION SERVICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2023
-----------------------------------------------------
Last Update Date | 03/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1574 CROTONA PARK E
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10460-4806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-726-9345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 90 STATE ST STE OFFICE40
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12207-1715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-726-9345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MS. KATHIE SHOULDERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 347-726-9345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------