Provider Demographics
NPI:1871972901
Name:EXECUTIVE CHARGE, INC
Entity type:Organization
Organization Name:EXECUTIVE CHARGE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:T
Authorized Official - Last Name:ENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-438-1100
Mailing Address - Street 1:1440 39TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3618
Mailing Address - Country:US
Mailing Address - Phone:718-438-1100
Mailing Address - Fax:718-249-1150
Practice Address - Street 1:1440 39TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3618
Practice Address - Country:US
Practice Address - Phone:718-438-1100
Practice Address - Fax:718-249-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB00381344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi