MEDICARE: GOLD MEDAL AMBULANCE

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)	1511057	NJ

General Provider Information

NPI Number	:	1336529114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLD MEDAL AMBULANCE

Provider Business Mailing Address
First Line	:	141 STRATFORD PL
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-1468
Country	:	US
Telephone Number	:	732-994-9929
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 STRATFORD PL
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-1468
Country	:	US
Telephone Number	:	732-994-9929
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MRS. REBECCA PERLMAN
Credential	:
Telephone Number	:	732-994-9929

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	06/05/2015

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Directions to “GOLD MEDAL AMBULANCE ” Practice Location

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