MEDICARE: COREY DAVIS

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	5579486	NY
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1750180220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY DAVIS

Provider Business Mailing Address
First Line	:	PO BOX 708
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-0708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 708
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-0708
Country	:	US
Telephone Number	:	718-440-0019
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2025
Last Update Date	:	03/10/2025

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Directions to “ COREY DAVIS ” Practice Location

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