Provider Demographics
NPI:1144899204
Name:MARDIA TRANSPORT SERVICE
Entity type:Organization
Organization Name:MARDIA TRANSPORT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE-PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-222-1110
Mailing Address - Street 1:17 BELMONT LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1633
Mailing Address - Country:US
Mailing Address - Phone:609-222-1110
Mailing Address - Fax:609-614-2065
Practice Address - Street 1:17 BELMONT LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1633
Practice Address - Country:US
Practice Address - Phone:609-222-1110
Practice Address - Fax:609-614-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2409347OtherTRANSPORTATION SERVICE