MEDICARE: EAGLE TES MEDICAL TRANSPORTATION

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	343800000X	Secured Medical Transport (VAN)	0400497218	NJ
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1588927032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE TES MEDICAL TRANSPORTATION

Provider Business Mailing Address
First Line	:	2978 KENNEDY BLVD STE 195
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-3820
Country	:	US
Telephone Number	:	201-478-2584
Fax Number	:

Provider Business Practice Location Address
First Line	:	2978 KENNEDY BLVD STE 195
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-3820
Country	:	US
Telephone Number	:	201-478-2584
Fax Number	:

Authorized Official
Title or Position	:	CEO-OWNER
Name	:	BASMAT ABUSHANAB
Credential	:	MT
Telephone Number	:	201-478-2584

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	06/20/2012

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Directions to “EAGLE TES MEDICAL TRANSPORTATION ” Practice Location

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