=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114351384
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENVISION MEDICAL TRANSPORT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2013
-----------------------------------------------------
Last Update Date | 04/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4301 BRISTOL DR
-----------------------------------------------------
City | UNION
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07083-2513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-258-7548
-----------------------------------------------------
Fax | 908-258-7548
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4301 BRISTOL DR
-----------------------------------------------------
City | UNION
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07083-2513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-258-7548
-----------------------------------------------------
Fax | 908-258-7548
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GREELENSKY CHARLES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 908-258-7508
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------