=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962693630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELTA INVALID COACH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2007
-----------------------------------------------------
Last Update Date | 08/07/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 52 COURTLAND ST
-----------------------------------------------------
City | PATERSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07503-2947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-272-3746
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 325
-----------------------------------------------------
City | PATERSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07544-0325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-272-3746
-----------------------------------------------------
Fax | 973-278-7797
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MR. SUMEER TOTEJA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-906-1800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | DELT000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------