Healthcare Provider Details

I. General information

NPI: 1376353631
Provider Name (Legal Business Name): AZANAVO WHEELS LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 STONEHAM RD
EWING NJ
08638-2745
US

IV. Provider business mailing address

31 STONEHAM RD
EWING NJ
08638-2745
US

V. Phone/Fax

Practice location:
  • Phone: 201-852-0233
  • Fax:
Mailing address:
  • Phone: 201-852-0233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. KEVIN KIGURU
Title or Position: GENERAL PARTNER
Credential:
Phone: 201-852-0233