Provider Demographics
NPI:1053880633
Name:K&M HUBBARD ENTERPRISE, LLC
Entity type:Organization
Organization Name:K&M HUBBARD ENTERPRISE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-315-5051
Mailing Address - Street 1:2465 ELIJAHS LN
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952-2412
Mailing Address - Country:US
Mailing Address - Phone:631-315-5051
Mailing Address - Fax:631-298-7117
Practice Address - Street 1:2465 ELIJAHS LN
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11952-2412
Practice Address - Country:US
Practice Address - Phone:631-315-5051
Practice Address - Fax:631-298-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0602Medicaid