Empire State Medi-Cab - A Premier Ambulette Service

Have questions? Call us now (631) 777-7333

Updated Friday January 11th, 2013 12:00pm EST


Transportion Request Form

Empire State Medi-Cab
555 Broadhollow Road
Suite 301
Melville, New York 11747
Phone: 631-777-7333
Fax: 631-777-7335

When possible, please try and schedule your transports at least 2 days in advance for scheduled medical appointments. We understand certain transports are needed with short or same day notice and we are here to help you. We welcome those spur of the moment transports and will work with you to make the best of a seemingly impossible transportation situation.

Note: For short term and same day transports, refrain from using our email option to schedule your transport. Calling our team will result in the best scheduling outcome.

To set up a trip with Empire State Medi-Cab, please fill out the form below. We will contact you with confirmation for your requested trip. If you do not here from us within one day, please contact our service team.

Fields marked with an * are required.

Transportation Request Form:

Transport Information

If Medicaid, please provide the Medicaid number of the customer