=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437594454
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFELINK MEDICAL TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2013
-----------------------------------------------------
Last Update Date | 05/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 98 HOOVER AVE
-----------------------------------------------------
City | PASSAIC
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07055-5221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-283-1600
-----------------------------------------------------
Fax | 732-283-4020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 98 HOOVER AVE
-----------------------------------------------------
City | PASSAIC
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07055-5221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-283-1600
-----------------------------------------------------
Fax | 732-283-4020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | SUMEER TOTEJA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-803-1210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 1612037
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------