MEDICARE: FOUR SISTERS 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	341600000X	Ambulance	100639	NJ

General Provider Information

NPI Number	:	1952711491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR SISTERS MEDICAL TRANSPORTATION

Provider Business Mailing Address
First Line	:	612 RIVERSIDE AVE
Second Line	:
City	:	LYNDHURST
State	:	NJ
Zip	:	07071-3004
Country	:	US
Telephone Number	:	201-613-4413
Fax Number	:	201-355-8567

Provider Business Practice Location Address
First Line	:	612 RIVERSIDE AVE
Second Line	:
City	:	LYNDHURST
State	:	NJ
Zip	:	07071-3004
Country	:	US
Telephone Number	:	201-613-4413
Fax Number	:	201-355-8567

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. PERLA ORDONEZ
Credential	:
Telephone Number	:	201-279-9543

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	04/13/2020

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Directions to “FOUR SISTERS MEDICAL TRANSPORTATION ” Practice Location

Language	Start Address	Practice Location

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