MEDICARE: ELEGANCE TRANSPORTATION GROUP 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	344600000X	Taxi		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881725216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEGANCE TRANSPORTATION GROUP LLC.

Provider Business Mailing Address
First Line	:	4140 ALBANY ST
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-4436
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 ERIE ST
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12204-2632
Country	:	US
Telephone Number	:	518-482-5000
Fax Number	:	518-482-5085

Authorized Official
Title or Position	:	OWNER
Name	:	MR. EUGENE REYES
Credential	:
Telephone Number	:	518-506-3000

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	08/22/2020

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