MEDICARE: CROSSTOWN CARE MED TRANSORT, LLC

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)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M41835160004545	OTHER	NJ	DRIVERS LICENSE

General Provider Information

NPI Number	:	1881030799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSTOWN CARE MED TRANSORT, LLC

Provider Business Mailing Address
First Line	:	2404 SYLVAN LN
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-2335
Country	:	US
Telephone Number	:	818-937-9588
Fax Number	:	908-354-1604

Provider Business Practice Location Address
First Line	:	2404 SYLVAN LN
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-2335
Country	:	US
Telephone Number	:	818-937-9588
Fax Number	:	908-354-1604

Authorized Official
Title or Position	:	CEO
Name	:	LETICIA C ROJAS
Credential	:	JD
Telephone Number	:	908-355-4768

Provider Enumeration Date	:	05/17/2013
Last Update Date	:	05/22/2013

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