=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568852507
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDIRUSH, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2015
-----------------------------------------------------
Last Update Date | 01/29/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38 BRUNSWICK WOODS DR 2ND FLOOR
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816-5601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-902-3587
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38 BRUNSWICK WOODS DR 2ND FLOOR
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816-5601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-902-3587
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. DANIEL FAINMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 908-902-3587
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 100654
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------