=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952711491
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOUR SISTERS MEDICAL TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2014
-----------------------------------------------------
Last Update Date | 04/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 612 RIVERSIDE AVE
-----------------------------------------------------
City | LYNDHURST
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07071-3004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-613-4413
-----------------------------------------------------
Fax | 201-355-8567
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 612 RIVERSIDE AVE
-----------------------------------------------------
City | LYNDHURST
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07071-3004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-613-4413
-----------------------------------------------------
Fax | 201-355-8567
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. PERLA ORDONEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-279-9543
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 100639
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------