MEDICARE: MULUBAH PORTAGE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1285445866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MULUBAH PORTAGE LLC

Provider Business Mailing Address
First Line	:	185 GLENWOOD AVE
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-2009
Country	:	US
Telephone Number	:	862-704-5852
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 GLENWOOD AVE
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-2009
Country	:	US
Telephone Number	:	862-704-5852
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EMMANUEL M KULLIE
Credential	:
Telephone Number	:	862-704-5852

Provider Enumeration Date	:	01/14/2025
Last Update Date	:	01/14/2025

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Directions to “MULUBAH PORTAGE LLC ” Practice Location

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