Provider Demographics
NPI:1073309548
Name:DARIUS, WILDMAEL
Entity type:Individual
Prefix:
First Name:WILDMAEL
Middle Name:
Last Name:DARIUS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CLENDENNY AVE # 1
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1111
Mailing Address - Country:US
Mailing Address - Phone:347-674-5941
Mailing Address - Fax:
Practice Address - Street 1:280 CLENDENNY AVE # 1
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1111
Practice Address - Country:US
Practice Address - Phone:347-674-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-19
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)