MEDICARE: SUPER FAST LIMOUSINE

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	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1205486834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPER FAST LIMOUSINE

Provider Business Mailing Address
First Line	:	4405 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-6838
Country	:	US
Telephone Number	:	718-438-6262
Fax Number	:	718-853-3446

Provider Business Practice Location Address
First Line	:	4409 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-6837
Country	:	US
Telephone Number	:	718-438-6262
Fax Number	:	718-853-3446

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RAUL IZQUIERDO
Credential	:
Telephone Number	:	718-690-4306

Provider Enumeration Date	:	09/16/2019
Last Update Date	:	11/28/2022

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Directions to “SUPER FAST LIMOUSINE ” Practice Location

Language	Start Address	Practice Location

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