MEDICARE: INNER CITY TRANSIT CORP.

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	1946510	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942463476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER CITY TRANSIT CORP.

Provider Business Mailing Address
First Line	:	371 CENTRAL AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-2842
Country	:	US
Telephone Number	:	973-481-6444
Fax Number	:	973-481-6461

Provider Business Practice Location Address
First Line	:	371 CENTRAL AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-2842
Country	:	US
Telephone Number	:	973-481-6444
Fax Number	:	973-481-6461

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LAWRENCE DAVIS
Credential	:
Telephone Number	:	973-481-6444

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	07/03/2008

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Directions to “INNER CITY TRANSIT CORP. ” Practice Location

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