Provider Demographics
NPI:1053596528
Name:SOVEREIGN TRANSPORTATION INC.
Entity type:Organization
Organization Name:SOVEREIGN TRANSPORTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-685-0843
Mailing Address - Street 1:5905 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4923
Mailing Address - Country:US
Mailing Address - Phone:718-435-0700
Mailing Address - Fax:718-851-4157
Practice Address - Street 1:5905 11TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4923
Practice Address - Country:US
Practice Address - Phone:718-435-0700
Practice Address - Fax:718-851-4157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02925597343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)