MEDICARE: CRAIGCO CARS 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	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1568955151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAIGCO CARS LLC

Provider Business Mailing Address
First Line	:	14 MANCHESTER BLVD
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-1519
Country	:	US
Telephone Number	:	631-697-5268
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 MANCHESTER BLVD
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-1519
Country	:	US
Telephone Number	:	631-697-5268
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CRAIG BLENMAN
Credential	:
Telephone Number	:	631-697-5268

Provider Enumeration Date	:	06/08/2018
Last Update Date	:	06/08/2018

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