Provider Demographics
NPI:1104254911
Name:GONJHEALTHTRASPOTATIONSORVESCOMPANY
Entity type:Organization
Organization Name:GONJHEALTHTRASPOTATIONSORVESCOMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:ESTREMERA
Authorized Official - Suffix:
Authorized Official - Credentials:CONSOLERT
Authorized Official - Phone:862-233-0197
Mailing Address - Street 1:135 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2420
Mailing Address - Country:US
Mailing Address - Phone:862-233-0197
Mailing Address - Fax:
Practice Address - Street 1:135 MADISON AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2420
Practice Address - Country:US
Practice Address - Phone:862-233-0197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GONJHEALTHTRASPORTAIONSORVESCOMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJA23440365892343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)