Individual
MAC SHOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
515 POND ST, SYRACUSE, NY 13208-2117
(315) 640-5457
Mailing address
515 POND ST, SYRACUSE, NY 13208-2117
(315) 640-5457
Taxonomy
Speciality
Code
Description
License number
State
347E00000X
Transportation Broker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
824371046
NON EMERGENCY MEDICAID TRANSPORT
NY
Enumeration date
06/26/2018
Last updated
06/26/2018
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