Provider Demographics
NPI:1902107964
Name:MED-X @HOME
Entity Type:Organization
Organization Name:MED-X @HOME
Other - Org Name:AMBI-NET TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-721-3700
Mailing Address - Street 1:PO BOX 715
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-0715
Mailing Address - Country:US
Mailing Address - Phone:732-721-3700
Mailing Address - Fax:732-721-2860
Practice Address - Street 1:540 BORDENTOWN AVE
Practice Address - Street 2:STE 4550
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1546
Practice Address - Country:US
Practice Address - Phone:732-721-3700
Practice Address - Fax:732-721-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)