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General NPI Number Information
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NPI Number | 1295366789
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Entity Type | Organization
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Legal Business Name | EVERGREEN TRANSPORT;LLC
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Dates
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Enumeration Date | 02/03/2020
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 680 AMBOY AVE
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-3120
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Country | US
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Telephone | 732-207-5893
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Fax | 732-777-1449
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Provider Business Mailing Address
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Address Line | 8 TREEVIEW LN
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City | CLIFFWOOD
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State | NJ
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Zip | 07721-1268
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Country | US
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Telephone | 732-207-5893
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Fax | 732-777-1449
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Authorized Official
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Title or Position | MANAGER ADMIN
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Name | WAHID S SHIBLI
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Credential |
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Telephone | 732-207-5893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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