MEDICARE: POSH SENIOR RIDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	343900000X	Non-emergency Medical Transport (VAN)
2	347C00000X	Private Vehicle
3	344600000X	Taxi

General Provider Information

NPI Number	:	1942868369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSH SENIOR RIDE

Provider Business Mailing Address
First Line	:	634 VANDOM ST
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11581
Country	:	US
Telephone Number	:	845-570-3821
Fax Number	:	718-764-4338

Provider Business Practice Location Address
First Line	:	1858 CORNAGA AVE
Second Line	:	2ND FLOOR
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691
Country	:	US
Telephone Number	:	845-570-3821
Fax Number	:	718-764-4338

Authorized Official
Title or Position	:	OWNER
Name	:	MR. YAAKOV JACOBOVITCH
Credential	:
Telephone Number	:	845-570-3821

Provider Enumeration Date	:	05/31/2019
Last Update Date	:	06/03/2019

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