MEDICARE: NEW JERSEY AMBULANCE ADMINISTRATION LIMITED LIABILITY COMPANY

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	341600000X	Ambulance

General Provider Information

NPI Number	:	1164749958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW JERSEY AMBULANCE ADMINISTRATION LIMITED LIABILITY COMPANY

Provider Business Mailing Address
First Line	:	16 CENTRAL PL
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-4302
Country	:	US
Telephone Number	:	862-224-1204
Fax Number	:

Provider Business Practice Location Address
First Line	:	526 PROSPECT ST
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-3216
Country	:	US
Telephone Number	:	862-224-1204
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADAM MOHAMMED
Credential	:
Telephone Number	:	862-224-1204

Provider Enumeration Date	:	05/03/2010
Last Update Date	:	02/27/2013

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