MEDICARE: GOSPAL CATHEDRAL BAPTIST CHURCH

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)

General Provider Information

NPI Number	:	1871441600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOSPAL CATHEDRAL BAPTIST CHURCH

Provider Business Mailing Address
First Line	:	300 S 12TH ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-1960
Country	:	US
Telephone Number	:	973-622-4934
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S 12TH ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-1960
Country	:	US
Telephone Number	:	973-622-4934
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STEFAN DURR
Credential	:
Telephone Number	:	973-900-0668

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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Directions to “GOSPAL CATHEDRAL BAPTIST CHURCH ” Practice Location

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