Provider Demographics
NPI:1053950915
Name:LESTAT CORP
Entity type:Organization
Organization Name:LESTAT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BURAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-747-0141
Mailing Address - Street 1:PO BOX 825406
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-5406
Mailing Address - Country:US
Mailing Address - Phone:201-335-0134
Mailing Address - Fax:
Practice Address - Street 1:651 RIVERSIDE AVE APT C47
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-3069
Practice Address - Country:US
Practice Address - Phone:201-335-0134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-24
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)