Provider Demographics
NPI:1194415265
Name:RIDGEWAY, DARNELL MICHAEL
Entity type:Individual
Prefix:
First Name:DARNELL
Middle Name:MICHAEL
Last Name:RIDGEWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1843
Mailing Address - Country:US
Mailing Address - Phone:607-661-7645
Mailing Address - Fax:
Practice Address - Street 1:240 GRAND ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1843
Practice Address - Country:US
Practice Address - Phone:607-661-7645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12830LY344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi