MEDICARE: VIP TRANSPORT OF PHILADELPHIA

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	344600000X	Taxi	4369561	PA

General Provider Information

NPI Number	:	1336510999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIP TRANSPORT OF PHILADELPHIA

Provider Business Mailing Address
First Line	:	2104 DERBY DR
Second Line	:
City	:	CINNAMINSON
State	:	NJ
Zip	:	08077-4519
Country	:	US
Telephone Number	:	856-498-0205
Fax Number	:	856-382-7412

Provider Business Practice Location Address
First Line	:	3360 N HOWARD ST
Second Line	:	C1
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-5800
Country	:	US
Telephone Number	:	856-498-0205
Fax Number	:	856-382-7412

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ADEL CHAOUCH
Credential	:
Telephone Number	:	856-498-0205

Provider Enumeration Date	:	10/08/2015
Last Update Date	:	10/08/2015

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