Provider Demographics
NPI:1902243355
Name:GENESIS MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:GENESIS MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-224-1204
Mailing Address - Street 1:16 CENTRAL PL
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4302
Mailing Address - Country:US
Mailing Address - Phone:862-224-1204
Mailing Address - Fax:
Practice Address - Street 1:526 PROSPECT ST
Practice Address - Street 2:SUITE B
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-3216
Practice Address - Country:US
Practice Address - Phone:862-224-1204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport