Healthcare Provider Details

I. General information

NPI: 1245436450
Provider Name (Legal Business Name): MED STAR MEDICALTRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 FORT LEE RD
LEONIA NJ
07605-1132
US

IV. Provider business mailing address

439 FORT LEE RD
LEONIA NJ
07605
US

V. Phone/Fax

Practice location:
  • Phone: 551-265-5692
  • Fax: 201-754-9756
Mailing address:
  • Phone: 551-265-5692
  • Fax: 201-754-9756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number554828554076050
License Number StateNJ

VIII. Authorized Official

Name: MR. JUSTIN ALEN SASSO
Title or Position: OWNER
Credential:
Phone: 551-265-5692