Healthcare Provider Details

I. General information

NPI: 1194975284
Provider Name (Legal Business Name): ELITE MEDICAL TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 12/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150-160 MAIN ST UNIT 15
ORANGE NJ
07050-3756
US

IV. Provider business mailing address

PO BOX 646
SOUTH ORANGE NJ
07079-0646
US

V. Phone/Fax

Practice location:
  • Phone: 855-354-8368
  • Fax: 973-928-8693
Mailing address:
  • Phone: 855-354-8368
  • Fax: 973-928-8693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberE0712037
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberE0712037
License Number StateNJ

VIII. Authorized Official

Name: MR. JOHN LOTIN
Title or Position: GENERAL PARTNER
Credential: EMT
Phone: 973-626-9052