MEDICARE: NEW IMAGE TRANSPORTATION, CAR AND LIMOUSINE SERVICES, 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)	5382725	NY

General Provider Information

NPI Number	:	1528422839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW IMAGE TRANSPORTATION, CAR AND LIMOUSINE SERVICES, LLC

Provider Business Mailing Address
First Line	:	1226 E 84TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4912
Country	:	US
Telephone Number	:	646-479-8703
Fax Number	:	718-209-0847

Provider Business Practice Location Address
First Line	:	1226 E 84TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4912
Country	:	US
Telephone Number	:	646-479-8703
Fax Number	:	718-209-0847

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RITCHIE TYSON
Credential	:
Telephone Number	:	646-479-8703

Provider Enumeration Date	:	04/12/2016
Last Update Date	:	04/12/2016

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