Provider Demographics
NPI:1427612605
Name:JUNIORS LUXURY INC
Entity type:Organization
Organization Name:JUNIORS LUXURY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:IZQUIERDO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:718-690-4306
Mailing Address - Street 1:6809 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5828
Mailing Address - Country:US
Mailing Address - Phone:718-940-1919
Mailing Address - Fax:718-462-6867
Practice Address - Street 1:1509 CORTELYOU RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5607
Practice Address - Country:US
Practice Address - Phone:718-859-1111
Practice Address - Fax:718-462-6867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1427612605Medicaid