Provider Demographics
NPI:1679764377
Name:MED-PORT TRANSPORTATION SERV
Entity type:Organization
Organization Name:MED-PORT TRANSPORTATION SERV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:TOTEJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-906-1800
Mailing Address - Street 1:57 DUFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1015
Mailing Address - Country:US
Mailing Address - Phone:973-762-9314
Mailing Address - Fax:973-762-9257
Practice Address - Street 1:57 DUFFIELD DR
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1015
Practice Address - Country:US
Practice Address - Phone:973-762-9314
Practice Address - Fax:973-762-9257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMEDP0003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7211902Medicaid