MEDICARE: GTWY 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	344600000X	Taxi	B01129	NY

General Provider Information

NPI Number	:	1477998755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GTWY INC.

Provider Business Mailing Address
First Line	:	4115 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5119
Country	:	US
Telephone Number	:	718-677-6666
Fax Number	:	718-253-5602

Provider Business Practice Location Address
First Line	:	4115 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5119
Country	:	US
Telephone Number	:	718-677-6666
Fax Number	:	718-253-5602

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ILYA KINKOV
Credential	:
Telephone Number	:	718-677-6666

Provider Enumeration Date	:	05/01/2013
Last Update Date	:	05/01/2013

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