1225407851 NPI number — COLLEGE POINT MOBILITY SHUTTLE TRANSPORTATION LLC

Table of content: CINDY CASTILLO MA, LPC (NPI 1780092668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225407851 NPI number — COLLEGE POINT MOBILITY SHUTTLE TRANSPORTATION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLLEGE POINT MOBILITY SHUTTLE TRANSPORTATION LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225407851
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9906 58TH AVE
Provider Second Line Business Mailing Address:
SUITE 2G
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11368-3714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-859-1587
Provider Business Mailing Address Fax Number:
718-699-7701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9906 58TH AVE
Provider Second Line Business Practice Location Address:
SUITE 2G
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11368-3714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-859-1587
Provider Business Practice Location Address Fax Number:
718-699-7701
Provider Enumeration Date:
09/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CRUTCHFIELD
Authorized Official First Name:
FREDIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-699-7701

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  LIC2-15-128629 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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