Healthcare Provider Details

I. General information

NPI: 1487157087
Provider Name (Legal Business Name): AIDEN FRANCIS TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CONGER ST APT 801A
BLOOMFIELD NJ
07003-3324
US

IV. Provider business mailing address

40 CONGER ST APT 801A
BLOOMFIELD NJ
07003-3324
US

V. Phone/Fax

Practice location:
  • Phone: 424-251-1341
  • Fax:
Mailing address:
  • Phone: 424-251-1341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberM10237507702782
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TOSTAO PEMBELE MBEMBA
Title or Position: OWNER
Credential:
Phone: 424-251-1341