Provider Demographics
NPI:1548354046
Name:MADISON INVALID COACH, INC.
Entity type:Organization
Organization Name:MADISON INVALID COACH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAZELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-680-1121
Mailing Address - Street 1:259 HOOVER AVE
Mailing Address - Street 2:SECOND FLOOR REAR
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3763
Mailing Address - Country:US
Mailing Address - Phone:973-680-1121
Mailing Address - Fax:973-680-1149
Practice Address - Street 1:259 HOOVER AVE
Practice Address - Street 2:SECOND FLOOR REAR
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3763
Practice Address - Country:US
Practice Address - Phone:973-680-1121
Practice Address - Fax:973-680-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAD040763416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6385206Medicaid
NJ6385206Medicaid