Provider Demographics
NPI:1316167372
Name:ANABELLA TRANSPORTATION LLC
Entity type:Organization
Organization Name:ANABELLA TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANATOLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSSOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-663-1006
Mailing Address - Street 1:120 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2605
Mailing Address - Country:US
Mailing Address - Phone:914-663-1006
Mailing Address - Fax:914-663-1248
Practice Address - Street 1:120 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2605
Practice Address - Country:US
Practice Address - Phone:914-663-1006
Practice Address - Fax:914-663-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02754396Medicaid