Healthcare Provider Details

I. General information

NPI: 1548522584
Provider Name (Legal Business Name): 123 MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 FRANKLIN AVE
BELLEVILLE NJ
07109-1703
US

IV. Provider business mailing address

321 FRANKLIN AVE
BELLEVILLE NJ
07109-1703
US

V. Phone/Fax

Practice location:
  • Phone: 973-851-1422
  • Fax: 973-925-5212
Mailing address:
  • Phone: 973-851-1422
  • Fax: 973-925-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberC07814107402782
License Number StateNJ

VIII. Authorized Official

Name: RINAT SHACHAR
Title or Position: OWNER
Credential:
Phone: 917-807-7220