Healthcare Provider Details

I. General information

NPI: 1609014745
Provider Name (Legal Business Name): 5 J MEDICAL TRANSPORTATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 ROUTE 46 EAST SUITE 101
CLIFTON NJ
07013
US

IV. Provider business mailing address

1117 ROUTE 46 EAST SUITE 101
CLIFTON NJ
07013
US

V. Phone/Fax

Practice location:
  • Phone: 973-767-2979
  • Fax: 973-767-2981
Mailing address:
  • Phone: 973-767-2979
  • Fax: 973-767-2981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. JOSE MIGUEL LOPEZ
Title or Position: CEO
Credential:
Phone: 201-230-9594