Provider Demographics
NPI:1427860808
Name:MO NY LOGISTICS
Entity type:Organization
Organization Name:MO NY LOGISTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TRANSPORT PROVIDER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-635-6167
Mailing Address - Street 1:884 BAY ST APT 3
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-4729
Mailing Address - Country:US
Mailing Address - Phone:585-635-6167
Mailing Address - Fax:
Practice Address - Street 1:884 BAY ST APT 3
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-4729
Practice Address - Country:US
Practice Address - Phone:585-635-6167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)