Provider Demographics
NPI:1194975284
Name:ELITE MEDICAL TRANSPORTATION
Entity type:Organization
Organization Name:ELITE MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTIN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:973-626-9052
Mailing Address - Street 1:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-0646
Mailing Address - Country:US
Mailing Address - Phone:855-354-8368
Mailing Address - Fax:973-928-8693
Practice Address - Street 1:150-160 MAIN ST
Practice Address - Street 2:UNIT 15
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-3756
Practice Address - Country:US
Practice Address - Phone:855-354-8368
Practice Address - Fax:973-928-8693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJE0712037341600000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)