Healthcare Provider Details

I. General information

NPI: 1841409752
Provider Name (Legal Business Name): MIRACLE INVALID COACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 WESTFIELD AVE SUITE 203
ELIZABETH NJ
07208-1658
US

IV. Provider business mailing address

520 WESTFIELD AVE SUITE 203
ELIZABETH NJ
07208-1658
US

V. Phone/Fax

Practice location:
  • Phone: 908-355-2235
  • Fax: 908-355-3116
Mailing address:
  • Phone: 908-355-2235
  • Fax: 908-355-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License NumberMIRA00383
License Number StateNJ

VIII. Authorized Official

Name: MR. SAIFELDIN SIDAHMED
Title or Position: PRESIDENT
Credential:
Phone: 908-355-2235