MEDICARE: EASTERN SUFFOLK TRANSPORTATION LLC

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)	38629	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194173054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN SUFFOLK TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	370 ROCKY POINT RD
Second Line	:
City	:	EAST MARION
State	:	NY
Zip	:	11939-1123
Country	:	US
Telephone Number	:	631-477-5912
Fax Number	:

Provider Business Practice Location Address
First Line	:	370 ROCKY POINT RD
Second Line	:
City	:	EAST MARION
State	:	NY
Zip	:	11939-1123
Country	:	US
Telephone Number	:	631-477-5912
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	HOLLY VESCOVI
Credential	:
Telephone Number	:	631-477-5912

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	06/01/2016

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