=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336510999
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIP TRANSPORT OF PHILADELPHIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2015
-----------------------------------------------------
Last Update Date | 10/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3360 N HOWARD ST C1
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19140-5800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-498-0205
-----------------------------------------------------
Fax | 856-382-7412
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2104 DERBY DR
-----------------------------------------------------
City | CINNAMINSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08077-4519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-498-0205
-----------------------------------------------------
Fax | 856-382-7412
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. ADEL CHAOUCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-498-0205
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number | 4369561
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------