| Doctor Name: | FATAI LASISI |
| NPI Number: | 1174979850 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 668842755 |
| Business Practice Address: | 13801 Springfield Blvd Springfield Gardens, NY - 114132632 |
| Business Phone Number: | 7187237269 |
| Business Fax Number: | 7187237262 |
| Mailing Address: | 13801 Springfield Blvd, SPRINGFIELD GARDENS |
| State: | NY |
| Postal Code: | 114132632 |
| Phone Number: | 7187237269 |
| Fax Number: | 7187237262 |
| NPI Enumeration Date: | 05/11/2016 |
| NPI Last Update Date: | 05/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 343900000X |
| License Number: | 668842755 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Non-emergency Medical Transport (VAN) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A land vehicle with a capacity to meet special height, clearance, access, and seating, for the conveyance of persons in non-emergency situations. The vehicle may or may not be required to meet local county or state regulations. |