MEDICARE: LEE'S AMBULATE AND TRANSPORTATION SVC.

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		NY
2	347E00000X	Transportation Broker		NY

General Provider Information

NPI Number	:	1295123214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE'S AMBULATE AND TRANSPORTATION SVC.

Provider Business Mailing Address
First Line	:	PO BOX 7451
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-7451
Country	:	US
Telephone Number	:	516-476-4029
Fax Number	:	516-476-4029

Provider Business Practice Location Address
First Line	:	107 BROADWAY APT 6
Second Line	:	APT 6
City	:	FREEPORT
State	:	NY
Zip	:	11520-7451
Country	:	US
Telephone Number	:	516-476-4029
Fax Number	:	516-476-4029

Authorized Official
Title or Position	:	OWNER/DRIVER
Name	:	MRS. VERONICA BUCKLES
Credential	:	TRANSPORTATION OWNER
Telephone Number	:	516-476-4029

Provider Enumeration Date	:	12/29/2014
Last Update Date	:	09/07/2023

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