Organization
DEDICATED TRANSPORTATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES MATTERA (PRESIDENT)
(718) 468-5643
Entity
Organization
Contact information
Practice address
9812 211TH ST, QUEENS VILLAGE, NY 11429-1006
(718) 468-5643
Mailing address
9812 211TH ST, QUEENS VILLAGE, NY 11429-1006
(718) 468-5643
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
B90582
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02410699
—
NY
Enumeration date
06/05/2007
Last updated
08/22/2020
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