MEDICARE: MOBILE LIFE SUPPORT SERVICES . INC

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	3416L0300X	Land Ambulance	M1212061	NJ

General Provider Information

NPI Number	:	1932301785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE LIFE SUPPORT SERVICES . INC

Provider Business Mailing Address
First Line	:	540 BORDENTOWN AVE
Second Line	:	STE 4A
City	:	SOUTH AMBOY
State	:	NJ
Zip	:	08879-1546
Country	:	US
Telephone Number	:	732-952-8755
Fax Number	:	732-952-8754

Provider Business Practice Location Address
First Line	:	540 BORDENTOWN AVE
Second Line	:	STE 4A
City	:	SOUTH AMBOY
State	:	NJ
Zip	:	08879-1546
Country	:	US
Telephone Number	:	732-952-8755
Fax Number	:	732-952-8754

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MISS NATALIYA MAGAGA
Credential	:
Telephone Number	:	732-952-8755

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	05/27/2014

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