Basic Information
| Provider Information | |||||||||
| NPI: | 1982804894 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUPERIOR MEDICAL TRANSPORTATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 LORD AVE | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115591341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6467723668 | ||||||||
| FaxNumber: | 7183273010 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 LORD AVE | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115591341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6467723668 | ||||||||
| FaxNumber: | 7183273010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2007 | ||||||||
| LastUpdateDate: | 07/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | LAHASKY | ||||||||
| AuthorizedOfficialFirstName: | EPHRAM | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6467723668 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 02618091 | 05 | NY | MEDICAID |