Healthcare Provider Details

I. General information

NPI: 1790738441
Provider Name (Legal Business Name): EDEN AMBULANCE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E RIDGEWOOD AVE
PARAMUS NJ
07652-4131
US

IV. Provider business mailing address

PO BOX 1398
PARAMUS NJ
07653-1398
US

V. Phone/Fax

Practice location:
  • Phone: 201-225-9339
  • Fax:
Mailing address:
  • Phone: 201-225-9339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberEDEN025
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0001449
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MR. SUMEER TOTEJA
Title or Position: MANAGER
Credential:
Phone: 732-803-1210