Healthcare Provider Details

I. General information

NPI: 1700510641
Provider Name (Legal Business Name): STATE-WIDE NON-EMERGENCY TRANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 PARK AVE
PLAINFIELD NJ
07060-2937
US

IV. Provider business mailing address

1371 PARK AVE
PLAINFIELD NJ
07060-2937
US

V. Phone/Fax

Practice location:
  • Phone: 908-205-0859
  • Fax: 732-627-0991
Mailing address:
  • Phone: 908-205-0859
  • Fax: 732-627-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: HERMAN JONES
Title or Position: COO
Credential:
Phone: 908-227-5068