Healthcare Provider Details

I. General information

NPI: 1093017618
Provider Name (Legal Business Name): ABBA MEDICAL TRANSPORTATION,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MAIN STREET
SOUTH AMBOY NJ
08879
US

IV. Provider business mailing address

PO BOX 275
KEASBEY NJ
08879-1642
US

V. Phone/Fax

Practice location:
  • Phone: 732-721-0911
  • Fax: 732-721-0919
Mailing address:
  • Phone: 732-721-0911
  • Fax: 732-721-0919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. EVAN WALKER
Title or Position: PRESIDENT
Credential:
Phone: 732-721-0911