MEDICARE: WILDMAEL DARIUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1073309548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILDMAEL DARIUS

Provider Business Mailing Address
First Line	:	732 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-3614
Country	:	US
Telephone Number	:	201-240-7924
Fax Number	:

Provider Business Practice Location Address
First Line	:	732 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-3614
Country	:	US
Telephone Number	:	201-240-7924
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2025
Last Update Date	:	06/19/2026

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Directions to “ WILDMAEL DARIUS ” Practice Location

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