MEDICARE: LIL D DISPATCH INC.

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	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1174736250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIL D DISPATCH INC.

Provider Business Mailing Address
First Line	:	6512 NEW UTRECHT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5725
Country	:	US
Telephone Number	:	718-256-7684
Fax Number	:	718-256-3386

Provider Business Practice Location Address
First Line	:	6512 NEW UTRECHT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5725
Country	:	US
Telephone Number	:	718-256-7684
Fax Number	:	718-256-3386

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. GAIL MIMOZO
Credential	:
Telephone Number	:	718-256-7684

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	08/22/2020

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Directions to “LIL D DISPATCH INC. ” Practice Location

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