MEDICARE: GOLDSTAR LIMOUSINE SERVICE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)		NJ

General Provider Information

NPI Number	:	1003302498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDSTAR LIMOUSINE SERVICE, INC

Provider Business Mailing Address
First Line	:	16 BAYBERRY DR
Second Line	:
City	:	LITTLE EGG HARBOR TWP
State	:	NJ
Zip	:	08087-9653
Country	:	US
Telephone Number	:	609-296-1464
Fax Number	:	609-296-4920

Provider Business Practice Location Address
First Line	:	16 BAYBERRY DR
Second Line	:
City	:	LITTLE EGG HARBOR TWP
State	:	NJ
Zip	:	08087-9653
Country	:	US
Telephone Number	:	609-296-1464
Fax Number	:	609-296-4920

Authorized Official
Title or Position	:	VP
Name	:	MR. ANTHONY J DALEO
Credential	:
Telephone Number	:	609-296-1464

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	07/09/2018

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