Provider Demographics
NPI:1730439415
Name:EXECUTIVE MEDICAL TRANSPORTATION
Entity type:Organization
Organization Name:EXECUTIVE MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-466-6200
Mailing Address - Street 1:318 21ST AVE
Mailing Address - Street 2:SUITE 318
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-3538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:318 21ST AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-3538
Practice Address - Country:US
Practice Address - Phone:787-466-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)