MEDICARE: SHORE TRANSPORTATION 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	343900000X	Non-emergency Medical Transport (VAN)	B01482	NY

General Provider Information

NPI Number	:	1740780519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHORE TRANSPORTATION INC

Provider Business Mailing Address
First Line	:	3173 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6443
Country	:	US
Telephone Number	:	718-646-6666
Fax Number	:	718-646-6213

Provider Business Practice Location Address
First Line	:	3173 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6443
Country	:	US
Telephone Number	:	718-646-6666
Fax Number	:	718-646-6213

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YURIY GERSHKOVICH
Credential	:
Telephone Number	:	718-646-6666

Provider Enumeration Date	:	02/17/2018
Last Update Date	:	02/17/2018

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Directions to “SHORE TRANSPORTATION INC ” Practice Location

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