=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467653956
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY MEDICAL TRANSPORTERS, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2007
-----------------------------------------------------
Last Update Date | 01/31/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 W WHITE HORSE PIKE 4A
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08009-2028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-236-6555
-----------------------------------------------------
Fax | 856-258-9341
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 W WHITE HORSE PIKE 4A
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08009-2028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-236-6555
-----------------------------------------------------
Fax | 856-258-9341
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. PATRICIA R GACUTAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-236-6555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------